Mental Diseases and Their Modern Treatment

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^

Tn

MENTAL DISEASES

AND

THEIR MODERN TREATMENT

BY

SELDEN HAINES TALCOTT. A. M., M. D., Ph. D.

MBDICAL SUPBRINTBNDBNT OF THB ICIODLBTOWN STATE HOMBOPATHIC

HOSPITAL IN MIODLBTOWN, N. T.; PROFB880R OF MBNTAL

DISBA8B8 IN THB NBW YORK HOMBOPATHIC

MBDICAL COLLBGB AND HOSPfTAL

NEW YORK

BOERICKE & RUNYON CO.

1901

COPYRIGHTED

I9OI

By BOBRICKE & RUNYON Co.

I DEDICATE THIS WORK TO THE

CLASS OF 1900

OF THE

NEW YORK HOMEOPATHIC MEDICAL COLLEGE

AND HOSPITAL

AND

TO ALL OTHER EARNEST STUDENTS OF

MENTAL MEDICINE

V

I

4

i

f

I

'\

I

i

PREFACE

During the past twenty-five years I have been en-
gaged in the practical Avork of ministering to the
needs of the insane. This work has resulted in a
gradual development of that form of treatment
which has been designated as **The Hospital Idea.''
In other words, the asylum has given place to the
hospital in the protection and restoration of mental
invalids. The fact is now generally recognized that
the insane man is a sick man, and needs for his com-
fort and cure the application of such means as are
ordinarily used for the benefit of the sick in a modem
general hospital. Acting under this belief, our
patients have been favored with such treatment as
may be best exemplified by skilled physicians, trained
nurses, and hospital methods and appliances. At
the Middletown State Homeopathic Hospital there
have been afforded not only hospital measures for
the recuperation of the mentally sick, but the
indicated homeopathic remedy has been applied
with conscientious fidelity in each case. Individual-
ization, and hospitalization, and homeopathic treat-
ment, have been the methods pursued in the in-
stitutions under my charge during the past quarter
of a century. This work emodies, in a series of

VI PREFACE.

lectures, a long experience in working for the good
of the insane. In it I have tried to explain the
nature of the disease under consideration; also
its causes, its tendencies, and its conclusions under
favorable treatment.

This work is not an exhaustive treatise upon in-
sanity. It consists simply of a few ** blaze marksj"
guiding the way through the wilderness of mental
disorder, and into the sunny fields of health. If it
shall become an aid to the medical student in the
acquisition of knowledge, and to the busy practi-
tioner in the care and cure of the sick, then its pur-
pose will have been accomplished.

The Author.

Middletowfiy N. K., April y igoi.

CONTENTS

lyECTURE I

THE HUMAN BRAIN

Its coverings, divisions and subdivisions, weight functions,
localization of functions, operations, uses abuses, and capa-
bilities . . . . - 9 to 30

LECTURE II

THR INSANK DIATHESIS OR ABNORMAI, TENDENCIES OF

THE HUMAN MIND

Definition. Causes, inherited and acquired. Evidences,
avoidance, and treatment 31 to 51

LECTURE III

SI.EEP, SI.EEPI.ESSNESS, AND THE CURE OF INSOMNIA

What is sleep ? The Condition for sleep. The natural causes
of sleep. Causes of insomnia. Suggestions for the induction
of sleep. Remedies 52 to 68

LECTURE IV

HISTORY AND CI.ASSIFICATION OF INSANITY, THEORIES, DEFI-
NITIONS, AND REQUIREMENTS FOR COMMITMENT

History. Classification of insanity. British classification.
American Classification. Theories, Definitions. Requirements
for commitment. Contra indications of commitment . 69 to 93

LECTURE V

MEI*ANCHOI,IA

Defitition. Causes. Forms. Symptoms, courses and cases.
Delusions. Prevalence and prevention. Pathological states. 94 to 1 26

LECTURE VI

MANIA

Characteristics. Causes. Forms. S3anptoms, courses and
cases. Pathological states . . . . . 127 to 158

VUl CONTENTS

LECTURE VII

DEMENTIA

Nature, Forms, Causes, sjrmptoms and treatment of acute
dementia. Chronic dementia. Masturbatic dementia.
Syphilitic dementia. Epileptic dementia. Organic demen-
tia. Alcoholic dementia. Senile dementia. Pathological
states i59toi8i

«

LECTURE VIII

GENERAI. PARESIS

History. Synonyms. Stages. Cases. Causes. Pathology.
Diagnosis, prognosis and treatment. Prevention . . 182 to 210

LECTURE IX

TREATMENT

At home. In sanitariums or State hospitals. Means for
treating the insane, kindness and gentle discipline, rest in
bed, enforced protection, exercise, amusement and occupa-
tion, artificial feeding, dietetics, moral hygiene, operations,
the hospital idea . . . . . . . 211 to 231

LECTURE X

MEDIC A I, TREATMENT

How to prescribe. Principal remedies for the treatment of
melancholia, mania, dementia, and general paresis - 232 to 245

HOSPITAI. CONSTRUCTION

Site. Construction of buildings. Solariums. Ventilation,
heating and lighting. Protection against fire. Furnishings
and decorations. Congregate and ward dining-rooms. Kit-
chen and bakery building. Boiler house, dynamo plant and
laundry. Cold storage building. Outbuildings for stock of
various kinds 245 to 263

COMPENDIUM OF MATERIA MEDICA.

Comprising the leading remedies and their principal indica-
tions in the treatment of mental disorders . . . 264 to 341

LECTURE I

THE HUMAN BRAIN

Three thousand years ago, more or less, there
\srere inscribed above the portals of the temple of
Apollo at Delphi these immortal words, "Gnothi
Seauton" {\vSiOi o-cavrdv), which, being translated from
the original Greek into the present vernacular of the
United States, means **Know Thyself/* That we
may know ourselves better than before, let us con-
sider to-day the human brain, its functions, its uses,
its abuses, and its capabilities.

No one can presume to unfold in all their fullness
and perfection the mysterious workings and the
marvelous mechanism of the human brain. So intri-
cate a subject can never be fully understood except
by the Infinite Mind that planned and brought into
action this rarest product of all creation. Still,
possibly, we may comprehend in a measure the
mechanism of the brain, and by carefal study come
to understand in some slight degree the uses of that
w^onderful organ, and also the disastrous effects of
its misuse.

We shall proceed to strip off the coverings of the

head and pursue our searches to the core, explaining

as we pass along, in brief, each part as we find it.

This work has, I presume, already been performed

by your professor of anatomy, and I shall merely

enumerate the component parts of the head in this

connection for the sole purpose of drawing your
2

10 MENTAL DISEASES

attention to a material structure as an organ of the
mind, and then pass to a contemplation of the sub-
tle processes of the mind itself.

The coverings of the brain are three in number :

1. The periostic (above the bone), — namely, the
hair, scalp, and muscles.

2. The bony cranium.

3. The sub-osseous, — namely, the membranes ly-
ing beneath the skull and over the cerebral mass.

The scalp is a thick, tough, tenacious covering,
forming the base and ground-work whence springs
that luxurious adornment, the human hair. The
scalp is thicker than the skin of any other portion of
the body. A thick scalp protects the brain from
accidental injuries. It is also supposed to prevent a
too rapid in-pouring of ideas upon the brain. The
scalp is attached to the skull by means of the occipi-
to-frontalis muscle. The latter covers the skull, and
has attachments along the crest of the brow, over
the eyes, and at the occiput, or back part of the
head. It is by means of this muscle that the brow^s
are elevated in token of surprise, or corrugated as an
evidence of displeasure or chagrin. The occipito-
frontalis muscle is thin even at its extremities or
points of insertion. Over the top of the head it is
but little more than a thick membrane or flattened
tendon.

Beneath the scalp and its controlling muscle, we
arrive at the skull, an egg-shaped, bony case, flat-
tened underneath, the forepart of which gives at-
tachments to the face. The skull is composed of flat
bones consisting of two layers, an outer and an
inner table, and a spongy tissue, known as diploe,
between them. Where the walls are very thin there
is but a single layer. The vault of the skull presents

AND THEIR TREATMENT, 11

two minute openings (the parietal foramina) for the
passage of small veins. At the base are many open-
ings for the transmission of nerves, and for other
purposes. The skull-cap proper is very strong, and
built to resist heavy blows. The base of the skull is
relatively weak and easily broken. The various
bones of the skull are laced or interlaced together by
what are called the sutures in such a way as to
oppose the tearing off of any bone by force acting in
a single direction.

On removing the skull-cap we arrive at the three
sub-osseous coverings called membranes. The first,
or that next the skull, is termed the dura mater,
which, as compared with the others, is thick and
exceedingly tense and firm, resembling in some slight
degree a drumhead or piece of parchment. Except-
ing on the crown, it is closely adherent to the skull,
with which it is very intimately associated, as
through its outward surfaces the minute vessels
w^hich supply the bony casing of the brain with
blood find their way. The inner surface of the dura
mater, that is, the surface next the brain, is smooth
and oily, so to speak, thus relieving the slight fric-
tion which takes place between the brain and its
protecting citadel, as the former swells into action
under the pressure of excitement or subsides into a
gratefiil calm during its appropriate periods for re-
pose. The dura mater forms still another protection
for the brain ; its density and firmness resisting with
vigor all encroachments from without, the splintered
fragments of a fractured skull even being held in
abeyance in many instances. By these appropriate
means the most vital organ of the body is protected
from fatal injuries.

The second membrane is termed the arachnoid

12 MENTAL DISEASES

from its supposed resemblance to a spider's web. It
is a single layer of thin, delicate, connective tissue
overhanging the convolutions of the brain, and div-
iding into two the spaces between the organ and
the skull. The outer of these is called the subdural
space, and the inner the subarachnoid. It was for-
merly supposed that the arachnoid membrane
formed a close sac like the pleura, which envelops the
lungs and lines the walls of the thorax, but investi-
gations have tended to disprove this theory. What
was supposed to be its outer, or reflected portion, is
really one of the layers of the dura mater. The chief
uses of the arachnoid seem to be to envelop and in
some measure to protect the brain, and to secrete a
fluid for the purpose of keeping it in a state best
adapted for the proper performance of its functions.

The third membrane, which is discovered as we
pursue our explorations, is termed the pia mater, or
delicate mother. This, too, like the arachnoid, is a
layer of connective tissue, but it performs the work
of holding together vast numbers of small arteries
and veins that carry on, to a large extent, the circu-
lation of the brain. This membrane is adherent to
the brain surfaces, covering closely the convolutions
and dipping into the sulci or spaces between them.
As the blood vessels pass into the brain from the pia
mater like so many little rootlets, the membrane is
of course fastened snugly to that organ.

The brain itself is divided into hemispheres. These
hemispheres are subdivided into lobes. The hemis-
pheres are separated by the great longitudinal
fissure which extends throughout the length of the
cerebrum in the middle line, reaching down to the
base of the brain in front and behind, but inter-
rupted in the middle by a broad band of white

AND THEIR TREATMENT. 13

matter termed the corpus callosum. This band
unites the hemispheres like the firm mass which
united the Siamese twins.

Each half of the brain is divided into what are
called the frontal, parietal, occipital and temporal
lobes ; and for a fifth lobe we have what is termed
the Island of Reil.

After removing the coverings we come to the con-
volutions. These are separated from each other by
depressions called sulci. It is supposed that the
deeper the sulci, the greater the brain power. This
is not always true, but the deeper the sulci the
greater the opportunity for a deposit of gray
matter.

Upon the outer surfaces of the convolutions, and
on the sides and bottom of the sulci, is a gray mat-
ter called the cortical substance. In the gray matter
there are five or six layers of nerve cells. Many of
these cells are shaped like a pyramid, while some are
round and some are elongated. The nerve cell has
a nucleus, a plasma, and a surrounding pellicle or
skin, and also outreaching tentacles or arms. The
entire outfit is called the neuron. Within the corti-
cal substance we find the white fibers which are in
reality the connecting wires of communication
between the nerve extremities of the body and the
neurine batteries of the brain. The nerve fibres con-
vey impressions to the cells, and the cells which
receive these impressions act according to the
impression which is made.

Besides nerve cells and nerve fibers there is a sub-
stance in the brain called the neuroglia. The neu-
roglia "is a transparent, nucleated, homogenous,
non-fibrillated matrix, somewhat resembling the
fibrillated connective tissue of the spinal cord."

14 MENTAL DISEASES

Supposing you were to put a lot of berries on some
strings, and then put them into a glass jar with the
ends of the strings hanging over the mouth of the
jar, and then fill in the interstices with some syrup,
this syrup might represent or typify the neuroglia.
After the Almighty had constructed the nerve cells
which are the homes and centers of mental activity,
and after He had connected them by nerve fibers
with the great organs and surfaces of the body, that
is, with the external world, He filled up the cracks
with neuroglia, which is simply connective tissue,
and other supporting material.

Histologically, you will remember that the cere-
bral mass is composed of gray matter filled with
cells of many kinds, of white matter (that is, white
nerve lines of communication), and of neuroglia,
which is a nucleated mass thrown in for the support
of the rest of the brain.

Having plodded through the brain, we arrive at
the base, and, as we expose it to view, we see the
longitudinal fissure, the corpus callosum, and its
peduncles, the lamina cinerea, the olfactory nerve, the
fissure of Sylvius, the anterior perforated space, the
optic commissure, the tuber cinereum, the inftmdi-
bulum, the pituitary body (which is said to be the
seat of the soul), the corpora albicantia, the poste-
rior perforated space, and the crura cerebri. Now I
trust that you will never forget any of these since I
have taken the trouble to bring them to your notice.

From the base of the brain are given off twelve
pairs of nerves. These are called nerves of sensation,
motion, and special sense, and are the mediums
through which impressions, both external a-nd inter-
nal, are conveyed to the brain, and through these all

AND THEIR TREATMENT, 15

orders of the mind to the body are conveyed for
execution.

The functions of seeing, smelling, tasting, and
hearing, are performed by the optic, olfactory, tri-
facial, and glosso-pharyngeal nerves. Portions of
those just named, and the remainder of the twelve,
constitute the nerves of sensation and motion.
Some anatomists name but nine pairs of nerves. We
prefer a division of twelve, and shall enumerate
them as follows :

1. Olfactory, 5. Trifacial, 9. Glosso-pharyngeal,

2. optic, 6. Abducens, 10. Pneumogastric,

3. Motor oculi, 7. Facial, 11. Spinal accessory,

4. Pathetic, 8. Auditory, 12. Hypoglossal.

There are in the brain five ventricles. The chief of
these are the lateral, and those of lesser importance
are the third, fourth, and fifth. The lateral are large
and occupy a considerable part of the cerebral
center, running in a general w^ay lengthwise along
the base, but always, according to Hogarth's line of
beauty, on a curve. The ventricles are important,
because we find in them the choroid plexuses which,
when diseased, tend to produce sleeplessness, and
insanity.

The next in importance to the lateral ventricles is
the fourth ventricle. This is bounded in front and
below by the medulla, and the reverse of the pons
which constitute its floor ; above and behind by the
cerebellum ; in front by the valve of Vieussens, and
the superior peduncle ; on the side by the restiform
bodies, part of the pons, and the lateral lobes of the
cerebellum. It is said that diabetes is due to some
diseased condition found in the floor of the fourth
ventricle.

The third ventricle extends anteriorly along the

16 MENTAL DISEASES

base of the brain to and between the optic thalami .
The space between the septum lucidum, w^hich is
very slight, is called the fifth ventricle.

All the true ventricles communicate with one
another; the two lateral with the third, the third
with the fourth at the aqueduct of Sylvius, the
fourth with the central canal of the spinal cord and
vsrith the subarachnoid space.

The significance of the ventricles lies in the fact
that effusions occur in them and thus the action of
the brain is either impaired, or destroyed.

The cerebellum, or little brain, is supposed to pre-
side over the functions of co-ordination, as they
relate to equilibrium, harmony and the symmetrical
action of the two parts of the body.

The medulla oblongata is the butt end of the
spinal cord. The band of union betw^een this end of
the cord, the cerebellum, and the cerebrum is termed
the pons varolii.

Viewing the brain from the standpoint of develop-
ment, we find that it is divided into three parts :

1. The forebrain, consisting of the olfactory
lobes, the cerebral hemispheres, and the parts sur-
rounding the third ventricle.

2. The midbrain, consisting of the corpora
quadrigemini, and the crura cerebri.

3. The hindbrain, consisting of the cerebellum,
the pons varolii, and the medulla oblongata.

This is the classification of Huxley, and is simple
and easily remembered.

The physiological peculiarity of the brain is that
it selfishly requires for its proper nourishment about
one-sixth of all the blood in the entire body.

The brain in the new-bom infant is said to weigh
about ten ounces. The average weight of the adult

AND THEIR TREATMENT. 17

brain ranges from forty to forty-eight ounces. The
brain of the celebrated Cuvier weighed over sixty-
four ounces, that of Abercrombie sixty-three, while
those of Agassiz, Daniel Webster, and a common-
daylaborer weighed about fifty-three ounces each.
The size of any given brain, all other things being
equal, determines its power. But the quality must
also be considered. This varies greatly. The brain
of Gambetta weighed but thirty-six ounces, while
the brain of a United States idiot weighed sixty-
seven ounces. The difference in the brain power de-
pends not alone upon the size, but also upon the
quality. The quality of the brain can generally be
determined by its achievements.

Great differences of opinion have existed with re-
gard to the period at which brains attain their full
size. Sir William Hamilton asserted that the brain
reached its maturity, as to size, at the age of seven
years. Other celebrated writers have claimed that
the brain matures between the twentieth and
thirtieth years. We believe that under ordinary
usage the brain matures gradually with the body,
and so long as the general system maintains
growth, so long the brain may continue to grow.
The head of Napoleon was small in youth, but ac-
quired in after life an enormous development. So it
seems that the force of an untiring and active brain
may assert itself even against its bony environ-
ments.

We come now to speak of the functions performed
by the brain. These may be divided into two
classes : (1) Those which preside over and direct the
various motions of the body, physical functions, so
to speak; and, (2) the higher or mental functions,

18 MENTAL DISEASES

wherein are involved cognizance, memory, and judg-
ment.

The action of the brain, in its relation to the
body, may be illustrated by comparing it to the ac-
tion of a spider in relation to its web. This famous
animal is usually found at home in the most central
portion of its self-constructed domicile. It may be
apparently asleep, but if you touch ever so lightly
one of the filaments of the spider's web, he instantly
takes notice of the fact, and seeks to repair the in-
juries which have been wrought. So the brain
stands like a sleepless Cerberus in the centre of the
much-diverging nerve fabric, and if you prick a nerve
extremity the shock is vibrated with lightning-like
rapidity to the brain, and from it goes forth the
order to the muscular guardians of the injured part
to hold the fort, or to beat a retreat, as may seem
best. A good illustration of nerve action is when a
boy sits down upon a bent pin, and then gets up
again.

Let us now attend to the localization of those
fimctions of the brain which direct and influence the
body. By applying the galvanic current to different
portions of the exposed brain in the case of a
monkey, and carefally noting the effects, it was
observed and determined that the excitement of one
part of the brain caused movements of the lower
limbs of the opposite side, as in walking. By stimu-
lating another portion of the brain, the muscles of
the forearm became flexed, w^hile stimulation of an-
other part would cause protrusion of the tongue,
etc. Repeated trials enabled the experimenters to
mark out on the brain the exact limits of these
physical fimctions, and within the circles thus de-
scribed, by due stimulus, action in some particular

AND THEIR TREATMENT. 19

part of the body was invariably excited. Thus were
the ftinctiotts of the brain in their relationships to
the functions of the body discovered and localized.

It was also discovered that certain portions of
the brain were not used in thus controlling the ac-
tions of the body. These unused portions are found
in the fore and hind parts of the brain. It is gener-
ally believed that in the anterior portion of the brain
the intellectual workings are carried on, while in the
hind part of the brain are located the centers of the
emotions, the passions, and the appetites.

It is an interesting fact that each portion of the
brain has its specific and special duty to perform.
This fact has been demonstrated by the experiments
of Fleurens, Longet, Velpeau, Ferrier, Hitzig, and
others. By removing successively portions of the
brain in some of the lower animals, the powers of
what remained were determined. When the upper
lobes of the brain were removed from a pigeon, that
bird was deprived of the powers of memory, and
w^ill ; but it could fly when thrown into the air, it
could be roused by a gentle push or pinch, by a light
flashed before its eyes, by ammonia held near its
nostrils, by a pistol discharged close to its head.
By removing another layer of brain tissue the
faculty of sight is destroyed, while hearing remains.
By removing still another layer the faculty of hear-
ing is destroyed ; and again, the power of motion is
paralyzed, and so on to the end of the chapter.
When we come to excise that center from which
the pneumogastric nerve springs, then the heart and
lungs are paralyzed and the animal dies. This is
true in all cases except that of the frog. A frog can
live for a short time by cutaneous respiration, for
scientific purposes, of course. The frog may be de-

20 MENTAL DISEBSES

capitated, and all nerve centers removed except
those located in the spinal cord, and then if a por-
tion of the belly be irritated with a drop of acid, an
attempt will be made by the frog to remove the irri-
tating substance by rubbing it off with his right leg.
Now cut off the right leg and you will see an at-
tempt to reach the irritated spot by the stump.
Not succeeding, the animal will pause and think it
over with his spinal cord, and then you will see him
try to remove the acid with his left leg.

We now pass to a consideration of the brain as a
seat of mental power, — the temporal kingdom of the
mind, the earthly tabernacle of the immortal soul.

Within the convolutions of the brain rest not only
the power of guiding and propelling the physical
forces, but, also, therein is the seat of a higher power
which enables man to control not only his own
actions, but to influence and direct the actions of
others ; to oppose successfully his intellectual vigor
and prowess against the crude strength of the lower
animals, and against the combative elements of
earth and sea and air.

Man's brain, in the first place, takes cognizance
of external things through perception or impression.
Next he stores away the fruits of cognizance in the
wine press and vaults of memory. From these come
forth at last the rich essence of judgment, the final
result of a subtle and mysterious process. The will
executes the mandates of the judgment.

The ancients thought that the brain was but a
useless mass of crude matter, a sort of overgrown
clam, a mountain snow-cap to keep the rest of the
body cool. The modem student finds that the brain,
wrhich the ancients despised, has become the chief
and most important organ of the human body. The

AND THEIR TREATMENT, 21

human mind, the occupant of this brain, is the
marvel and the mystery of creation. It is swayed
by every flitting passion or impression, and yet it is
held in steady poise by the calm monitions of reason,
of cultivated judgment, and of developed will. In
these respects it resembles those wondrous rocking-
stones reared by the ancient Druids. You remember
that they were so finely balanced that the finger of a
child could vibrate them to their centers, and yet they
vsrere so firmly poised that the might of an army
could not move them from their base. So it is with
the human mind w^hich has been thoroughly trained,
carefiiUy cultured, and kept by its owner as a pearl
without price. The smile of a child can sway it to
and fro, while the fagot of martyrdom could not
change one jot or tittle of its firm determination.

Let us see how the brain works during the evolu-
tion of thought. It is claimed that there are two
classes of intellectual faculties, — the knowing, and
the reflecting. The knowing faculties are individu-
ality, form, size, weight, coloring, locality, etc. The
reflecting faculties are comparison, and causality.
Each faculty has, it is said, a separate portion of the
brain for its home. The memory belongs to each
faculty. Hence there are as many kinds of memory
as there are homes for the knowing and reflecting
faculties. Sometimes by reason of localized brain
disease a person may lose the power of recalling a
name, or place, or event, and yet may be able to
exercise his memory with regard to all the faculties
except the one which has been disturbed by disease.

Memory is simply a retentive attribute or power
of the mind. The best view to take of memory is to
regard it as the holding of a feeling, a thought, or
a purpose in the continuous life of the mind. Every

22 MENTAL DISEASES

thinking act continues, every choice and purpose
likewise remain part of the mind's activity. The
law of retentiveness in the mind imposes three condi-
tions for a good memory. They are found :

1. In the subject matter of remembrance,

2. In the relationship of each thing remembered
to other things in the mind, and,

3. In the care of the mind itself.

The first condition is that the mind accepts read-
ily only what it most needs or wishes to use ; there-
fore, you should get good things to remember. The
second is to associate them carefiiUy with things
already remembered in such a manner that they
may be easily recalled. The third condition for
securing a good memory is to give your full atten-
tion, without day-dreaming or mind-wandering, to
the subject that you may wish to memorize.

Professor Bain classifies mental activities as fol-
lows:

1. The senses — ^that is, the five senses,

2. The intellect, or the mental processes w^hich are
developed between impressions on the one hand and
determination on the other,

3. The will, with which the judgment is closely
associated,

4. The emotions.

The products of the senses are called sensations.
The products of the intellect are ideas, beliefs, im-
aginings, derived from processes of reasoning and
understanding and arriving at the conclusion of
judgment. The products of the will are volitions;
and the products of the emotions are feelings and
passions.

The first step in mental activity is self-conscious-
ness. The mind takes cognizance of an impression

AND THEIR TREATMENT, 23

produced upon the brain by any of the j&ve senses.
When the brain receives an impression from any
source, and the mind becomes conscious of it, then
there is formed within the mind what are called
perceptions. The power of perceiving and comparing
is called the intelligence. The intelligence is the
mind's faculty of knowing. After receiving various
and repeated impressions, and after forming numer-
ous comparisons of objects which we often see, we
find at last that there has been developed an auto-
matic function, so to speak, and this is known as
intuition. Intuition is the faculty of internal percep-
tion and internal comprehension. Intuition is a lim-
ited sphere of mental phenomena. It is an incom-
plete phenomenon. From this we pass on to a com-
plete knowledge, and thus the faculty of thought is
stirred into activity. Thought is the elaborative
faculty, the comparative faculty, the faculty of rela-
tionships. Well, we put several thoughts together,
and let them have a warlike struggle, and this
process of fighting, of thoughts rubbing against
each other, and concluding either victory or defeat,
we call reasoning. After this fight of thoughts has
been carried on until final facts or conclusions are
distinguished from primal inference, after the good
has been distinguished from the evil, and truth from
falsehood, after the monkey and the parrot have
both got through, there is brought in a verdict of the
whole matter, and this is called judgment. Judgment
is that faculty which enables the mind to ascertain
truth by comparing facts and ideas. Judgment is the
faculty of opinion put by the individual upon facts
with which he has become acquainted, and upon
ideas which have been generated within his own
brain. A judgment having been formed, the wiU rises

^ I

24 MENTAL DISEASES

and executes the mandates of the judgment. The will
is the power of determining upon final action, and
upon the will human achievement largely depends.

Now remember that intellectual action of the
mind works as follows : First, you have impression
through one of the senses ; then perception of that
impression, that is consciousness; then intuition,
then thought, then reasoning, then understanding,
then judgment, then will.

Beyond the intellectual workings of the human
mind, we have, as a compass to guide the will, what
men call conscience. Theodore Parker, when a little
boy, was tempted one day to kill a spotted tortoise,
but a voice spoke to him and said **It is wrong." He
looked around, and seeing no one, fled in great fear
to his mother, and told her what he had heard and
asked her w^hat it was that spoke to him in that
way. The mother took the child in her arms, and
said: **Some men call it conscience, but I prefer to
call it the voice of God speaking in the soul of man.
If you heed that little voice it will always guide you
aright.''

The will is swayed and impelled, or hindered, by
what are called the emotions. The emotions have
been subdived into feelings, and passions. The ex-
tremes of feeling are termed pleasure, and pain.
These vary through all grades of intensity, from the
faintest flush of satisfaction, to the brightness of
ecstatic joy; from the slightest cloud of discontent,
to the stormiest violence of grief and agony. They
intermingle with all the experiences and energies of
the mind, intruding upon every affection, investigat-
ing every movement of the intelligence, and animat-
ing or disheartening every activity of the free w^ill.
Passions are represented on the one extreme by love,

AND THEIR TREATMENT, 25

and on the other by hate. When these are but par-
tially developed, we may feel pity, or disgust, or con-
tempt for objects about us.

Emotions are sometimes awakened by the idea
that things are true, or beautiful, or good. Such
emotions are called the intellectual sense, the
aesthetic sense, and the moral sense. Again, the
emotions may be excited by the originality or new-
ness of the idea. If new and incongruous, it is
known as the emotion of the ludicrous. An emo-
tion when vividly presented in bright language is
termed repartee.

Again, the mind is the parent of desires. Some
may be normal and healthful, while others are ir-
regular and morbid. Desires belonging to the physi-
cal constitution are commonly known as appetites.
Healthful appetites, when naturally satisfied, cease
their craving, and disappear until the health and
well-being of the body reawaken them. Unnatural
appetites continue their demands for that which is
unhealthy and injurious. The will is not always en-
ergetic enough to subdue such appetites. Concern-
ing unnatural appetites, Charles Dickens has de-
clared that" vices are sometimes only virtues carried
to excess.''

And, now, as we rehearse these various and
numerous faculties of the mind, we come to the con-
clusion that the mind is single, yet with a plurality
of functions. It is the same mind that feels, that
thinks, and that wills ; and in putting forth either of
these functions it never entirely ceases from the
others. Consequently, every mental state has some-
thing of feeling, something of intelligence, and some-
thing of volition, or endeavor. It is so with the

body. The body puts forth simultaneously various
3

26 MENTAL DISEASES

fanctions of animal life. It breathes, it circulates its
blood, it digests, it secretes, and it receives, and
transmits sensations. Not one of these bodily func-
tions need be suspended while the others are in exer-
cise. The human mind works as a unit. One function
may appear temporarily to overshadow by its
prominence all others, and yet the other functions
are by no means suspended. The various functions
of the mind shade into each other with an infinitely
varying degree of prominence, and thus give a kalei-
doscopic character to the mental states.

It needs but little reflection to conclude that the
uses to which our brains must be subjected are both
intricate and multitudinous. They have a priestly
charge and oversight over those living temples so
"fearfiiUy and wonderfully made'* by the hand of
Infinite Wisdom; and they are likewise the tem-
porary lodging places of the immortal soul. The
brain is the great storehouse of fact and the factory
of thought. It takes up by its inherent action the
scenes and sounds by w^hich it is surrounded; it
gorges itself upon the experiences of the past; it pro-
trudes itself, through hope and imagination, upon
the great undiscovered future. Within the serried
ranks of cell and fibre, of matter gray and white,
there is involved in meshes, too intricate to unravel,
a mysterious union of the material and the imma-
terial. The theories of the wisest are too feeble to
express it, the explorations of the ages have failed to
discover or explain in fall the unfathomable phe-
nomena of mental action. Materialistic theorists
find no satisfactory conclusions from their varied
and persistent investigations - of the human brain
and its marvellous workings. From action to in-
action, from life to death, the search for the truth

AND THEIR TREATMENT, 27

has been and is being most carefully made. The
brain is the sheltering home of mentality, of im-
mortal being, too, but you might as well count the
rafters of a church, and from the enumeration thereof
declare the character of the congregation therein
assembled, as to attempt to educe from an examina-
tion of the brain after death a conclusive theory as
to the nature of man. And yet the investigation
goes on, and the problem of human life will by-and-
by be solved. Gradually the cause and effect of per-
ception, impression, and ratiocination, will be surely
evolved.

The practical uses to which our brains are
adapted are those of self-preservation and self-im-
provement. With what critical care, then, should we
begin and continue the exercise of that organ upon
whose proper development and growth depend the
life, the happiness, the prosperity, and progress of
the individual possessor of so rare a gift ! The young
should be taught to regard the brain in their posses-
sion as the pearl of great price. Brain culture of the
right kind should begin at the earliest possible period
in life, and "should be continued without undue inter-
ruption, until man bends his head low to escape the
rafters in the western horizon. This does not mean
hard study, but proper training in childhood. Our
brains should always be used with moderation and
steadiness, but with unswerving persistence. Upon
this care and culture depends not only the growth of
the individual, but, by such means are fortifications
erected to repel the assaults of man's greatest enemy
— ^insanity.

The best uses of the brain are those in which all
the forces of that organ are bent to the service of

28 MENTAL DISEASES

right, and are forever arrayed against the hordes of
wrong.

The worst abuse of the brain is a prostitution of
its powers before the juggernaut of sin and error. It
is a moumftd fact that great powers and great
abuses are often found in close company. The exer-
cise of these powers, and the exemplification of
w^rong use are often manifest in the life and career of
a single individual, and sometimes they are manifest
in the acts of a community, or a nation.

While we recognize the po^wers and achievements
of the human mind, yet w^e can never see that mind
at work. The wisest thought of the philosopher, or
the finest conception of the poet, may produce no
observable action of the brain. The school boy's
determination to run a^sray from school may pro-
duce as much effect upon his brain as Avas produced
upon Caesar's or Napoleon's when one decided to
cross the Rubicon, and the other to scale the heights
of Saint Bernard. But while we cannot see the
actual wrorkings of the human mind, ^ve are yet able
to trace in history the effects of those workings. To
attempt to measure the work of the brain in civiliza-
tion would be but an attempt to measure civiliza-
tion itself. A greater range of mental and moral
perceptions, and a superior fineness of mental and
moral culture, are really all that have been gained
in the centuries of human life. I am speaking, of
course, of the permanent possessions of the human
mind. What is preserved in the intellectual life of
the past in books, pictures, architecture, and sculp-
ture, is an available aid of great value. But apart
from this, something has been preserved of the
strength and culture which habits of thinking pro-
duce, and this is all that man can definitely claim as

AND THEIR TREATMENT. 29

his own ; all else is outside of himself and may be
destroyed. But while we all understand, abstractly,
that the brain is the seat of intellectual life, and that
it impels all human action and shapes all human
destiny, yet there are few so well instructed that
they would not be filled with surprise and wonder at
what one man may do. In mingling with the masses
of human beings, the thought impressed most forci-
bly upon us is the Uttleness, the insignificance, of
an individual life. Count a hundred of those you
will first meet on your way to-morrow morning,
and the chances are that the world would not fed
the slightest loss if they were to be instantly swept
out of existence ; nor would it lack anything of its
intellectual acquisitions if they had never been.
What more painfiil, humiliating illustration of man's
littleness! But you can count a hundred names
whose loss, if they should be taken from civilization,
would make immeasurable mutilations. What
empty shelves in our libraries ; what vacant spaces
on the walls of our galleries of art; what grand
structures, the inspirations of genius and of faith,
would disappear! What rents would be made in
laws, in constitutions, in religious creeds ! But more
impossible to estimate than all else would be the
weakening of the intellectual fibre, and the depletion
of the intellectual strength, of the living brain. It
is by considering these great men whose displace-
ment would wrench the world ; it is by studying and
trying to measure their work, that we come, in part,
to appreciate the capabilities of the human brain.
Biography when truthful, and the subject is noble as
well as great, is one of the most useful of studies.
Nothing else gives us such grand ideas of our nature,
such consciousness of strength, such buoyancy of

30 MENTAL DISEASES

hope, such honorable pride. Nothing else fills us
with such longings, or so stirs emulation, and stimu-
lates action ; and nothing else imposes upon us more
forcibly the importance of correct mental training.

We have pointed out very briefly, some of the nor-
mal functions of the brain and mind, in order that
we may understand more readily those departures
from the normal status which constitute the disease
known as insanity. We shall in our next lecture
seek to disclose those conditions, and impulses, and
forces, which tend to the production of mental dis-
order; "but that is another story."

LECTURE II

THE INSANE DIATHESIS

OR

ABNORMAL TENDENCIES OF THE

HUMAN MIND

It has been truly said that ** man is the product of
his antecedents multiplied by his environments."
Our lecture to-day will concern both of these factors
in the sum of human experience.

Dr. Duncan, of Chicago, classifies babies under
two heads,— namely, the **acid" and the '* alkaline;"
and from such a physiological standpoint he argues
new methods by which our infant population may
be best trained in the way it should grow. Dr.
Grauvogel, in his metaphysics of medicine, entitled
"The Text Book of Homoeopathy," designates the
various constitutions of the human body as **hydro-
genoid," **oxygenoid," and "carbo-nitrogenoid."
As inherent characteristics may be thus classified
and designated, why is it not equally legitimate to
specify other natural or acquired mental abnormal-
ities by terms of a similar basic import?

Mental abnormality is always due to either im-
perfect or eccentric physical development, or to effects
of inborn or acquired physical disease, or to injurious
impressions, either ante-natal or post-natal, upon
that delicate and intricate physical structure known
as the human brain. Some physical imperfections

32 MENTAL DISEASES

more than others give rise to mental derangements.
Some persons, more than others, when affected by
any bodily ailment, tend to aberrated conditions of
the mind. Some impressions, more than others, are
peculiarly unfortunate by reason of their corroding
eflfects upon the brain tablets of a sensitive mind.
To these natural defects and unnatural tendencies,
we apply, in a general way, the term "The Insane
Diathesis. '* This is a state or condition in mental
pathology corresponding to those diatheses so com-
mon in physical pathology, namely, the scrofalous,
the cancerous, the scorbutic, the rheumatic, the
gouty, and the calculous. The insane diathesis is a
general term applying to all those conditions which
tend to the inception and growth of mental
unsoundness. This diathesis may be either inherited
or acquired. In the former case it may be compared
to the scrofulous; and in the latter, to the gouty
diathesis.

Those who are bom to become insane do not
necessarily spring from insane parents, or from an
ancestry having any apparent taint of lunacy in the
blood. But they do receive from their progenitors,
oftentimes, certain impressions upon their mental
and moral, as well as upon their physical being,
which impressions, like iron moulds, fix and shape
their subsequent destinies. Hysteria in the mother
may develop the insane diathesis in the child.
Drunkenness in the father may impel epilepsy, or
mania, or dementia, in the son. Ungovemed pas-
sions, from love to hate, from hope to fear, when in-
dulged in overmuch by the parents, may unloose the
furies of unrestrained madness in the minds of the
children. Even untempered religious enthusiasm

AND THEIR TREATMENT. 33

may beget a fanaticism that camiot be restrained
within the limits of reason.

As the development of progress is slow and
gradual, so likewise is the development of degener-
acy. As men attain high moral and intellectual
achievements only through the efforts of succeeding
generations, so it seems but natural that the insane
should oftentimes trace their sad humiliation and
utter unfitness for the duties of life back through a
tedious line of passion unrestrained, of prejudice,
bigotry, and superstition unbridled, of lust un-
checked, of intemperance uncontrolled, of avarice
unmastered, and of nerve resource wasted, ex-
hausted, and made bankrupt before its time.

Here are dangers to the human race w^hich potent
drugs cannot avert. Here are maladies which
medicines cannot cure. But the medical man, the
conservator of the public health, realizing the
dangers which threaten his community or state,
may help, if he will, to parry those pathological
blows which the present aims at the future ; and, by
timely warnings and appeals to his clients of to-day,
may save them for his own treatment, instead of
consigning them to an asylum where his own fees
cease from doubling, and the crazed ones are at rest.

Causes

Now what are the causes, the outward evidences,
of internal degeneracy, and the best means for the
prevention of this early beginning, steadily growing,
far reaching curse which comes only to torment its
victims with purgatorial tortures before the time ?

The causes of the insane diathesis are most fre-
quently traceable to the methods of life of those who

34 MENTAL DISEASES

produce children under such circumstances and con-
ditions that their offspring bear the indelible birth-
mark of mental weakness. A cause is found in the
early dissipations of that father who brings to the
work of perpetuating his kind only an exhausted
and enfeebled body, and a demoralized and blas6
mind. A cause is discovered in the mother who con-
tributes her mite to earthly immortality, but who
tarnishes that mite with the dross of her own unholy
and unhealthy existence. Fast living, such as society
in many cases seems to demand, is a fruitful cause of
the mental imperfections so common among the
rising generation. The sons of royalty, and the sons
of the rich, are often weak in cerebral force because
of the high living of their ancestry. Many of the
high livers of the present day are developing, rapidly
and surely, strong tendencies to both mental and
physical disorders. Elbert Hubbard says of those
who waste their substance upon the Waldorf-
Astoria air, that they are apt *Ho have gout at one
end, general paresis at the other, and Bright's dis-
ease in the middle.''

Causes of the insane diathesis are developed from
the parent's undipped imagination, or sordid desire,
or base motive, or succession of mean action, or trial
of fear, or passion of remorse, or undue, gratifica-
tion of the appetites, or depletion of the bodily sys-
tem through over-use, or from any perversion of the
physical, mental, or moral powers. The insane dia-
thesis is a product of all those forces which tend to
rack and wreck the minds and bodies of those whose
lives do not conform to the highest precepts of the
laws of nature. It is a "genetic evolution" of the
worse from the bad.

AND THEIR TREATMENT, 35

* ' Cursed be the social wants l^at sin against the strength of youth!' '

** Cursed be the sickly forms that err from honest nature's rule ! "

Not only is the insane diathesis the fruit of wrong
living and wrong thinking in the early lives of the
parents, but it is often the result of peculiar states
in which the reproducing pair find themselves at the
supreme moment of conception ; and, likewise, in the
unpleasant emotions induced by the surroundings of
the mother during pregnancy. Drunkenness, lust,
rage, fear, mental anxiety, or even incompatibility,
if admitted to participation in the act of impregna-
tion, will, each in turn or in combination, often set
the seal of their presence in the shape of idiocy, im-
becility, eccentricity, or absolute insanity. The
famous Diogenes recognized this fact w^hen he re-
proached one of those half-witted, crack-brained un-
fortunates, with the remark: "Surely, young man,
thy father begat thee when he was drunk.'' Burton,
in his Anatomy of Melancholy, also states that "If
a drunken man gets a child it will never likely have
a good brain." And the wise Michelet predicts:
"Woe unto the children of darkness, the sons of
drunkenness who were, nine months before their
birth, an outrage on their mothers." And again:
" He who is bom of a nocturnal orgy, of the very
forgetfttlness of love, of a profanation of the beloved
one, will drag out a sad and troubled life." The
children of drunkards are often sad and hideous bur-
lesques upon normal humanity.

Other unfortunate passions and conditions exert
as deleterious effect upon the formative process of
ne\sr human life as drunkenness. As an example we
give the following authentic case : A father had the

36 MENTAL DISEASES

pkasure of seeing two of his sons grow up strong
and vigorous, mentally and physically, while a third
was weak, irresolute, fretful, suspicious, and half
demented. He confessed to his physicians the cause
of this family mishap in these words: "In the
summer of 18 — I failed, owing to my rogue of a
partner running off with all our money. No man
perhaps ever felt such a misfortune more keenly than
I did, and it seemed to me I should never get over
the shock. I w^as completely unmanned, and feared
I should go crazy. Well, during this state of things
my wife conceived, and there is the result. Poor S^!
He inherits just the state of mind I was then in."

Scores of such cases might be cited. Such warn-
ings are neither single nor singular. Such conse-
quences are the inevitable results of an utter dis-
regard of the simple and plain requirements of
nature. A sound body and a cheerful mind can only
be produced from healthy stock. Those who multi-
ply, with disease in their bones, care on their minds,
and canker in their hearts, simply perpetuate and
intensify their own pains and sorrows and cares.

Unpleasant influences brought to bear upon the
mother during the period of pregnancy, are marked
by a production of a vast variety of mental pecuUari-
ties. Historical, scientific, and medical works, are
replete with the untimely records. Rizzio was mur-
dered in the presence of his paramour, Mary, Queen
of Scots, she being at that time pregnant with
James the Sixth. Her son, though a monarch, and
bom to rule, had a constitutional timidity of tem-
perament, and a great terror of a drawn sword.
This was due to the shock of seeing her lover killed
while she was pregnant. Ishmael practiced the
insanity of hate because his mother lived with that

AND THEIR TREATMENT, 37

emotion uppermost in her heart while bearing
within her body the germ of a nation of haters.
The first Napoleon became a great warrior, and
cherished the delusion of destiny, because his mother,
while carrying him in her womb, "exercised queenly
powers over her spirited charger and the subordi-
nates of her husband,*' and daily associated with the
bravest and the best, as well as the most supersti-
tious, of the French army.

Those of you who wish to pursue farther the
study of the laws of heredity, may do so by consult-
ing the works of Ribot, of Galton, and of Lucas.

Children bom under the influence of fear are quite
likely to be troubled with apprehensions of impend-
ing calamity so intense that they, at last, become
insane. Mr. P — murdered his wife and nine children.
Fear pervaded the minds of several pregnant women
in the neighborhood lest they should meet with a
similar fate ; and the children bom soon after grew
up to be crazed by the same emotion that had
almost paralyzed their feminine progenitors. An
insane man always manifested the greatest fear of
being killed, and constantly implored those around
not to hurt him. His mother had lived with a
drunken husband who had often threatened to kill
her, once pursuing her \srith a carving knife. She
managed to escape, and shortly afterwards gave
birth to this son, w^ho w^as constantly possessed
with the pangs of fear, until he finally took his own
life that he might escape apprehended dangers.

Not only individuals, but communities, are some-
times affected by some intense emotion which per-
vades the minds of all the inhabitants of the country.
Esquirol remarks that the children bom soon after
the horrors of the French Revolution turned out to

^ I

38 MENTAL DISEASES

be weak, irritable, susceptible, and liable to be
thrown by the least excitement into insanity. The
same may be said of children bom during the war in
this country, extending from 1861 to 1865.

As we have already stated, the insane diathesis
may be acquired as well as inherited, and by the
following means :

1. By imperfect nutrition,

2. By slight and almost imperceptible injuries to
the brain — ^blows or falls,

3. By those fears which are sometimes excited in
the minds of young children for purpose of govern-
ment,

4. By overtaxing the undeveloped physical
powers,

5. By unwise forcing of the mind in its immature
or undeveloped stage,

6. By premature and unnatural excitement of the
sexual organs of the young,

7. By suppression of the ambitions, and powers,
and tastes, and desires, of the enthusiastic ado-
lescent.

Insanity is a result of a diseased condition of the
brain, either ftmctional or organic, and it manifests
itself most frequently by mental disturbance or dis-
tress, and by the expression of delusions or halluci-
nations. It is easy, therefore, to comprehend the
fact that whatever tends to the weakening of the
cerebrum, or exhaustion of the central forces of life,
must necessarily favor the inception and growth of
insanity. Lack of proper nutrition for the brain is,
then, a prime cause of acquired mental abnormality.

As severe blows upon the head produce immediate
and dangerous diseases of the brain which often
speedily terminate the lives of those injured, so slight

AND THEIR TREATMENT. 39

blows, quickly forgotten, perhaps, not infrequently
result in stealthily developed, but none the less dan-
gerous, conditions, which eventuate in the derange-
ment of all the mental faculties. There can be no
law too severe for the punishment of those who
strike children on the head. If you see a parent or
teacher boxing the ears of a child, it is your Chris-
tian duty to secure his arrest and punishment. He
is guilty of slow murder of the innocents. These
fiends in human form are the arch-enemies of devel-
opment and progress.

As fright to the mother, before her child is bom,
may produce an unfortunate impression upon the
offspring, so fright to the young child, occasioned by
threats of punishment, by locking up in dark rooms,
or by stories of greedy bears or grinning ghosts,
produces, oftentimes, a mental shock that makes the
child wretched in early life, and drives him into
insanity at a later date.

As insanity is most prevalent among the working
classes, and as it frequently succeeds utter exhaus-
tion of all physical forces, it follows most conclu-
sively that overwork of the young is a permanent
cause of gravitation towards lunacy. Our factories,
shops, and stores, not only produce and display
artistic and usefal wares, but when the young are
employed in them, and overtaxed by day and night,
they become the feeders of hospitals for the insane,
as well as producers of material for premature
graves. The regulation by law of the hours during
which young operators may work, and the legal
limitations which prevent very young persons from
working in factories at all, are wise and usefal
measures for the general w^elfare of the community.
But the effort in this direction should be continued

40 MENTAL DISEASES

until a proper standard of comfort, and care, and
fair treatment, has been established in every work-
ing centre.

One of the most common causes of acquired ten-
dency to insanity is the forcing system employed in
the education of the young. While we believe that
a proper education and training of the human mind
is one of the best prophylactics against insanity, we
hold also that, like all other agencies which, when
misdirected, become the most terrible instruments of
evil, the system of popular education, as now prac-
ticed in many of our schools and colleges, is fraught
with dangers that are likely, unless checked, to
destroy the very end it is intended to accomplish.

Instead of seeking, first, to insure a sound physical
basis for the mental superstructure, our present
methods tend to break down physical health, to dry
up the primal sources of existence, and to bring to
eventual wreck all the powers of body and of mind.
These dangers arise not so much from the amount of
work required, as from the amount of anxiety and
w^orry which this work induces in the minds of sen-
sitive children. Many children of the present genera-
tion are sensitive, with nervous temperaments, and
they are easily aflfected by the strain of mental toil.
Such children should be held in check, or guided by
enlightened intelligence, profound wisdom, and
ripened judgment, on the part of the teachers. Deli-
cate children should be kept much in the open air, and
taught to exercise their muscles until they are fully
developed physically. The brain of the child should
lie fallow until general physical strength and
stamina are insured. Every possible means for de-
veloping the physical structure to perfection should
be adopted in the training and education of children

AND THEIR TREATMENT. 41

'whose ancestry has been cultivated and refined over-
much from a mental standpoint. Especially should
every child be taught to breathe slowly and deeply,
and be made to realize the fact that every deep
breath of pure air drawn into the lungs adds to the
potency of energy,and the prolongation of life.

When our public educators come to appreciate the
sublime fact that the human body and the physical
brain must be first sufficiently developed and per-
fected, and that mental growth must be judiciously
restrained, and that the minds of the young must be
guided in their early achievements with discriminat-
ing judgment, then our schools will no longer be
hot-beds for the propagation of imbecility, nor
gardens for the cultivation of lunatics. Mental cul-
ture may accompany physical growth, but always
in the order of an army following its leader.

When perfect discipline is attained, and the hour
for battling with the world arrives, then the mental
forces of those who are physically strong will cer-
tainly march to the front, and they will take with
them the inspirations of health and good blood.
The truant school boy often makes the most success-
ful man because he has insisted upon a proper devel-
opment of his own physical resources, and in this
w^ay he has acted upon his own responsibility.

That grand philosopher, Herbert Spencer, refer-
ring to the evils of intellectual cramming, voices a
timely warning to both youth and age in these em-
phatic words: "On old and young the pressure of
modem life puts a still increasing strain. Go where
you will, and before long there come under your
notice cases of children, or youths of either sex, more
or less injured by undue study. Here, to recover

from a state of debility thus produced, a year's vaca-
4

42 MENTAL DISEASES

tion has been found necessary. There you will find
a chronic congestion of the brain that has already
lasted many months, and threatens to last much
longer. Now you hear of a fever that has resulted
from the over-excitement in some way brought on
at school. And, again, the instance is that of a
youth who has already had once to desist from his
studies, and who, since he has returned to them, is
frequently taken out of his class in a fainting fit.*'

And again: **How commonly constitutions are
thus undermined will be clear to all who, after not-
ing the frequent ailments of hard-worked profes-
sional and mercantile men, will reflect on the dis-
astrous eflFects which undue application must
produce upon the undeveloped system of the young.
The young are competent to bear neither as much
hardship, nor as much physical exertion, nor as
much mental exertion as the full grown. Judge,
then, if the ftiU grown so manifestly suffer from the
excessive mental exertion required of them, how
great must be the damage which a mental exertion,
often equally excessive, inflicts upon the young.''

A marked case of imperfect nutrition and mental
overwork resulting in insanity came under my
notice. The patient, a young ambitious Welshman,
w^as brought up on a farm where he w^as over-
worked and indifferently fed. From this hard and
monotonous life he passed to the severe study and
indoor confinement necessary to preparation for col-
lege. Though slight in form and weak in body, he
succeeded in his new work remarkably well, and
was a leader in intellectual achievements at the
academy in his native village. After graduating
from the academy he entered college, but only to
breakdown under the unnatural strain; and in a few

AND THEIR TREATMENT. 43

weeks he passed from the quiet shades of learning to
the shadier refuge of an insane asylum. The diathe-
sis in this case was acquired by the means men-
tioned, for there is no history of hereditary taint,
and no other causes for insanity to be found. Such
a case illustrates both the unwisdom of the victim
for pursuing such a suicidal course, and the folly of
his parents in permitting it to be entered upon by
the son. It should also serve as a warning to those
who are yet free from the distressing toils of unwise
scholarly ambition.

In addition to the dangers of excessive mental
strain which beset the young in our present hot-beds
of learning, we find a leading and growing tendency
to excess in social pleasures. We find that the days
are passed in exhausting study, and the nights given
over to unrestrained social enjoyments. Business
and pleasure should always find a happy and
harmonious combination in our daily lives, but the
amount of each should be very much reduced in the
daily round of the average young American. Ex-
cessive athletic sports are likewise dangerous, and
produce disastrous consequences upon both the
heart and the brain.

Children in schools are not only sometimes over-
worked, but in some boarding schools they are also
very apt to be underfed. Hurried and imperfect feed-
ing on the part of the young should be scrupulously
avoided. While you may live happily on very plain
and inexpensive food, it should always be carefully
and properly cooked. You should secure good, plain,
w^holesome fare in abundance, if you would succeed
as a student. My advice to every young man or
woman is to keep his or her stomach full of good
nourishing food, and to acquire an education at a

44 MENTAL DISEASES

slow but systematic pace. Eat apples, oranges, oat-
meal porridge, cracked wheat mush, graham bread,
fresh eggs, peas and beans, salads and olive oil, and
but little meat. The ancients lived to be one hun-
dred and twenty years old with eyes undimmed, and
they ate and drank and flourished on **com, wine,
and oil.*'

Another cause of the insane diathesis lies in pre-
mature, improper, and unnatural use of the sexual
organs. Many of the hospitals for the insane pre-
sent histories and marks of this unfortunate habit.
Every unnatural use and over-excitement of the
sexual organism tends not only to epilepsy, but to
imbecility, mania, and dementia. The young should
be taught to avoid masturbation because it is a
source of much mental weakness and abnormality.

Again, the suppression of ambition, or taste, or
desire, leads to disappointment and mental depres-
sion in the young. A boy may wish to enter one of
the learned professions, or to take up some mercan-
tile pursuit, but through the force of circumstances
he may be obliged to engage in some menial toil,
and thus a laudable ambition is sacrificed to neces-
sity. A girl may have a taste for music or painting,
but the binding and repressing force of poverty may
prevent the gratification of such a taste, and this
may lead to bitter disappointment and depression
of all the mental faculties. The repression of a
natural desire may impel its victim to drift into the
slough of despond. These subtle causes of mental
disorder should be carefiiUy considered, and every
commendable impulse of the young should be grati-
fied so far as possible, in order to avoid the pitfall of
insanity. There is no country in the world where
the possibility of rising to eminence, to fame, and to

AND THEIR TREATMENT, 46

fortune is so broad, so bright, and so encouraging as
in this favored land. And yet there is no country in
the world more replete with broken wrecks of disap-
pointed ambition than this. We meet such wrecks
in every street and thoroughfare of the great cities,
and along the highways and byways of the country.
They flock about the tables of the money changers in
Wall street ; and they hover, like flies, in the neigh-
borhood of every office or position of honor, politi-
cal or otherwise, throughout the length and breadth
of the several states. When the means used for the
gratification of man's ambition fail, when hope de-
ferred has made the heart sick, then there creeps in a
mental state and a physical condition which favor
most strongly the production and the ripening of
insanity. A reasonable ambition is necessary for the
accomplishment of every noble task, but that ambi-
tion is unwise and unholy, when, under its effiects, the
young break down and wear out prematurely, and
when under its sweeping shock they become dis-
gruntled wrecks which even the gentle ministrations
of an insane asylum cannot possibly repair. Moder-
ate ambition will lead to ripe achievement ; excessive
ambition is worse than the battle path of glory, for
it "leads but to the grave *' direct, while the former
drags its victims through years of weary suffering
before the rest of the tomb is vouchsafed to their
tired bones.

Now the question arises : What are the outward
evidences of the insane diathesis ? They are numer-
ous and complicated. They present themselves in
every varying shade of imperfect physical develop-
ment, in endless varieties of cranial contour, and in
numerous types of facial expression. To understand
them most fully, let us present an historical model of

46 MENTAL DISEASES

a well-balanced brain, and contrast it with the ap-
pearance of one whose tendency is to mental
obliquity.

Every one recognizes a healthy constitution and
rare mental equipose when the name of the illustri-
ous Washington is mentioned. No one ever sus-
pected the Father of his Country of leanings toward
insanity. What regularity invested his every feat-
ure ! What benevolence and good sense characterized
and tempered his expressions ! He had passions like
unto other men ; but he likewise possessed wonderful
powers of self-control. Undisturbed amid the whirl-
ing storms of popular excitement, Washington with-
stood many shocks before which weaker men would
have been swept into the pitfall of insanity. Few
men are further removed from inclination to mad-
ness than was the immortal Washington.

Contrast the brain symmetry of such a man with
the uncanny shapes and illogical action of onew^hose
bent is ever toward that which is incongruous and
intellectually dicrotic. Picture the benign features
of the first President, and again behold in the de-
scription of Dickens the distorted countenance of a
Quilp, chattering vengeance against those around
him. Contrast the beaming expression of him who
w^as first in his countryman's hearts with that
wretched Barnaby Rudge of whom the master of
novelists writes : **Hewas about three and twenty
years old, and though rather spare, of fair height
and strongly made. His hair, of vsrhich he had a
great profusion, hung about his face and shoulders,
and gave his restless looks an expression quite un-
earthly — enhanced by the paleness of his complexion.
* * * * Startling as his aspect was, there was
something plaintive in his wan and haggard looks.

AND THEIR TREATMENT, 47

For the absence of the soul is far more terrible in a
living- man than in a dead one ; and in this unfortu-
nate being its noblest powers were wanting. In his
face there was wildness and vacancy/'

Had Dickens better understood the mysteries of
psychology, he would not have claimed that the soul
was absent, but that it found but a faint expression
through the unfortunate medium of a soggy and
misshapen brain.

In the faces of those whose diathesis is that of a
sickly mentality, there are always the marks of dis-
order and desolation. Their **dome of thought*' is
but a dilapidated ** mansard," and the windows of
their souls are darkened from within by an unseemly
and non-protective armament against approaching
storms.

The heads of those who are bom or bred to
insanity are almost always misshapen. One side is
fttUer than the other ; one ear is set higher than the
other; the eyes peer forth in a restless uncertain way
from beneath beetling brows ; the nose slants slightly
across the face ; the mouth has an uneven cut, and
the lips match each other but poorly.

There are also in such persons a great variety of
expression — the sinister, the ugly, the mock-sober,
the leering, the vacillating, the tricky. There may
be developed, unmistakably, in the features of the
prospective lunatic the malice of the mule, the cun-
ning of the fox, the grinning fiendishness of the
hyena, or the sedate sottishness of swine. All these
external marks and appearances are but the mir-
rored images of distorted minds. Inherent crooked-
ness is thus oftentimes forcibly displayed, and the
tendencies of the inner man to wallow in the mire of
mental ruin are ever thus revealed.

48 MENTAL DISEASES

Are there means for avoiding the development
and growth of the insane diathesis? Are there
means for the cure or relief of transmitted or ac-
quired mental defects ? Here are questions which the
generations of the past have left unanswered. Yet
the solution of such problems may, I believe, be ac-
complished.

To avoid the evils liable to arise from the propa-
gation of the insane diathesis, the parties to the
crime must pause and study the new philosophy of
life — a philosophy which shall guide them to the ac-
complishment of good and noble results, rather than
to those which are ignoble and demoralizing to
humanity. The avoidance of debasing passion ; the
putting away of that cup whose contents is adder's
juice ; the shunning of all unnecessary anxiety and
cares of life, and in their stead the patient cultiva-
tion of all higher virtues and better tempers, will, at
last, insure an offspring that will not only bless their
ancestry, but will fill the earth with happiness, and
health, and contentment of mind and spirit.

"Like begets like'' though with increasing or de-
creasing intensity not only in physical contour, but
in mental symmetry or mental idiosyncrasy; and
not only are the general thoughts and emotions of
the parents impressed upon their children, but even
the flitting passion of a moment may cast a cloud of
darkness over an entire life, just as the silvered
sheet of the photographer receives a fadeless impres-
sion from a transient ray of sunlight. The mind of
the unborn, like the cylinder that revolves in the
phonograph, may receive impressions of happy or
unholy thoughts, and reproduce them with faithful
accuracy in the years to come ; aye ! even when the
brain of the mother is but dust, and her heart no

AND THEIR TREATMENT, 4^

longer responds to any emotion, and her guiding
hand is palsied by the chilling touch of death.

To that "holy of holies" then, the sacred temple
of procreation, should be brought only such oflFer-
ings as are sure to prove acceptable to the Lord of
Nature. While the mother bears within her being
the helpless new life, there should surround her a
magic presence of benign and stimulating influences,
from which influences the coming mind may draw
inspirations that shall feed and nourish and develop
all its forces to a symmetrical perfection.

When once the human being has appeared upon
the carpet of life, then the practical work of develop*
ment and growth should begin. The great end
should now be to remedy, as far as possible, all in-
herent defects, and to promote the growth of all
possible virtues and powers. The child should be
watched over,- and guided, and guarded with the
same jealous care that was, or ought to have been,,
exercised toward the mother during the sacred
term of pregnancy. If proper care is taken, the
ungainly in body and the weak in mind may develop
both symmetry and usefulness. Even in the worse
types of mental disease there are some salient and
bright spots upon which good influences may act :

** There is some soul of goodness in things evil,
Would men observingly distil it out.'*

Bright surroundings, pleasant associations, stim-
ulating encouragements, abundant food of the best
and plainest quality, fresh air, active exercise, in
the clear sunlight, together with simple direction
not forcing of the mental faculties, will in the course
of patient time produce from even poor stock such a
robust and cultured race as to be the astonishment
of those who iumish and mold the material.

50 MENTAL DISEASES

In making these marches to higher and better
things, we may, I think, be permitted to state that
homoeopathy has already done much, and will do
more, with the medicines at her command. Medi-
cine may not only cure active disease, but, if properly
applied, it may act as a stimulus in the growth and
development of the human body. Such remedies as
Calcarea Carbonica, and Hepar Sulphur, and Graph-
ites, and Phosphorus, and Sepia, and Silicea, and
Sulphur, have here a field of action surpassing any in
which they have heretofore wrought. The "tissue
remedies,'' so-called, are, we believe, destined to win
triumphs in this new arena, which shall transcend
all the glories of medical achievement in the past.
God hasten the day when we may learn how to
wield aright these mighty weapons against fatefiil
heredity and acquired degeneracy !

In conclusion, we offer another warning and an-
other injunction to the young, to the efiect that not
only must the mental powers be protected from pre-
mature exhaustion by overwork, but they must also
be fortified against the too common dissipations of
youth, and sustained by the recuperative influences
of timely and abundant sleep. It is natural to be
spendthrift of those gifts which have been lavishly
bestowed upon us, and of which we seem to have an
exhaustless supply. Hence we waste our youthful
vigor, amid scenes of exciting folly, not only by day,
but through the long-drawn and precious hours of
the night — ^hours that are precious because of their
designed purpose to replenish and restore the inevi-
table wastes of life. Through moderation alone are
happiness and health long-conserved. The midnight
lamp of the worker, and the midnight lamp of the
pleasure seeker, alike consume with undue avidity

AND THEIR TREATMENT. 51

the cruse of oil allotted to each one's life. Therefore
the lamp must be put out early if the owner would
live long and well in the land.

Not only must excessive waste be shunned, but
restoration and repair must be steadily and perse-
veringly attained. The sin of omission is quite as
heinous as the sin of commission. To neglect the
maintenance of one's powers, in their fullest possible
measure, is as deplorable and wrong as the throw-
ing away of strength already acquired.

The precepts embodied in such experiences and
such teachings as we have endeavored to trace in
this lecture are, we believe, sound and practical. If
the medical profession would rise to the duty of
properly warning both the young and their natural
guardians, and if these would give heed to such
warnings, then the incomputable evils of premature
forcing of the brain would be averted ; the folly of
dissipation would be shunned, the necessity for
ceaseless repair would be recognized, and the sources
of mental unsoundness, now burdened with a
tropical luxuriousness, would become barren and un-
productive as the sullen shores of the dark Dead Sea.

LECTURE III

SLEEP, SLEEPLESSNESS, AND THE CURE

OF INSOMNIA

To-day we shall seek to discuss the nature and
quality of sleep — Sleep, "the twin sister of Death."
We shall also portray the necessity for sleep, and
nature's method for securing it. Again, we shall
consider the causes of sleeplessness ; and finally, we
shall endeavor to point out the safest and surest
dietetic, medical, and other means for the cure or re-
lief of insomnia.

Some of you have already learned that sleepless-
ness is one of the prime and leading indications of
approaching insanity. Still, there are many excep-
tional cases of insomnia which do not terminate in
mental unsoundness. But insomnia is so often the
forerunnner of mental disorder, that it seems proper
to devote one lecture of the course on mental dis-
orders to a consideration of sleep and sleeplessness.

Probably no writer in ancient or modem times
has so fully discussed the subjects of somnia and in-,
somnia as the immortal Shakespeare. Hence, when
w^e would know of sleep and sleeplessness — of the
beneficial eflfects of the one, and the distressing qual-
ities of the other, we naturally turn for information
to the luminous pages of the most wonderful poly-
chrest thinker that the world has ever produced.
When we go back to the days of the Bard of Avon,
we find firom him who "held the mirror up to

MENTAL DISEASES AND TREATMENT, 53

nature'* that many a time and oft the "fiing'd
curtains of his eyes were all the night undrawn."
Shakespeare recorded his own experience as well as
that of the men and women who lived in his time.

The sleep of age and of youth is described when
Friar Laurence says :

*' Care keeps his watch in every old man's eye,
And where care lodges, sleep can never lie ;
But where nnbruised youth with unstuff 'd brain
Doth couch his limbs, there golden sleep doth reign.**

The tranquillity of sleep is outlined here :

** And to conclude, the shepherd's homely curds,
His cold thin drink out of his leather bottle.
His wonted sleep under a fresh tree's shade.
All which secure and sweetly he enjoys.
Are far beyond a prince's delicates."

Worry is one of the great causes of sleeplessness :

" O polish'd perturbation ! Golden care !
That keep'st the ports of slumber open wide
To many a watchful night ! Sleep with it now !
Yet not so sound, and half so deeply sweet.
As he, whose brow with homely biggin bound.
Snores out the walch of night."

The .best cause of sleep is honestly acquired
fatigue from active exercise :

** Weariness
Can snore upon the flint ; when restive sloth
Finds the down pillow hard."

The tired boy sleeps better than the monarch :

'* Canst thou, O partial Sleep, give thy repose
To the wet sea boy in an hour so rude.
And in the calmest and most stillest night,
with all appliances and means to boot.
Deny it to a King? Then, happy low, lie down !
Uneasy lies the head that wears a crown."

54 MENTAL DISEASES

The golden qualities of sleep are such as to be-
come blessings and benisons from friends to friends :

*' Sleep, Richmond, sleep in peace and wake in joy.
Thou quiet soul, sleep thou a quiet sleep.**

This was Romeo's invocation to Juliet :

** Sleep dwell upon thine eyes ; peace in thy breast.*'

The goodness of Lady Mortimer is set forth when
the poet declares :

*' She will sing the song that pleaseth thee,
And on thy eyelids crown the god of sleep.**

Titania to her lover says :

*' 1*11 give thee fairies to attend on thee.
And they shall fetch thee jewels from the deep,
And sing, while thou on pressed flowers dost sleep.**

In behalf of fallen heroes, Titus said :

** There greet in silence, as the dead are wont.
And sleep in peace, slain in your country's wars.**

Also the poet declares that in that land of the
blest there

** Are no storms.
No noise, but silence and eternal sleep."

A lack of sleep is the most horrible of earthly
terrors :

** No sleep close up that deadly eye of thine,
Unless it be while some tormenting dream
Affrights thee with a hell of ugly devils.

** Sleep shall neither night nor day
Hang upon his pent-house lid ;
He shall live a man forbid.

* ' Not poppy nor mandragora,
Nor all the drowsy syrups of the world.
Shall ever medicine thee to that sweet sleep
Which thou own'dst yesterday.**

AND THEIR TREATMENT. 56

The blessings of sleep, on the other hand, are
further outlined as foUow^s :

" With him above
To ratify our work, we may again
Give to our tables meat, sleep to our nights.*'

** How sweet the moonlight sleeps upon that bank."

*• The best of rest is sleep."

** Our little lives are rounded with a sleep.**

These quotations from the dramas and tragedies
of Shakespeare, illustrate the fact that history re-
peats itself, and that the experiences of humanity
are much the same through all the centuries.

Sleep is a prime and urgent necessity of our
natures. To secure it in abundance, with system
and regularity, is the aim of the philosopher, the
dream of the poet, and the easy accomplishment of
the workingman. The natural conclusion is that we
should all utilize a portion of our time by building
railroads, or by digging canals, or, like Gladstone,
by chopping down trees.

What is sleep ? We are told that *' it consists of a
temporary suspension of the fttnctions of the cere-
bral portions of the nervous system.'' Sleep is the
act of closing the doors of the brain against external
intrusion while the process of rest and repair is
going on within.

The process by which sleep is induced is that of a
moderate anemia, or lessened blood supply to the
brain. This anemia, while sufficient to quiet the
ordinary operations of the mind, is not far enough
advanced to restrict the processes of repair in the
brain. The theory of cerebral anemia during sleep is
supported by the experiments of Alexander Fleming,

56 MENTAL DISEASES

i:he investigations of Durham, and the observations
of the state of the retina during sleep with the
ophthalmoscope by Hughlings-Jackson. Fleming
tried compression of the carotid arteries, and suc-
-ceeded in causing sleep. Durham removed the skuU-
<:ap from dogs, and noted that in these animals,
when asleep, the brain was always anemic. Hugh-
lings-Jackson found that the expansions of the optic
nerve are paler and less congested during sleep than
^t other times.

Not only is the brain less fully supplied with
blood during sleep, that is, not only is the volume
^decreased, but the velocity with which it flows is
likewise diminished. The heart's action is slower
and less active during sleep than during wakefulness.

A hyperemic condition of the brain stimulates the
greatest mental activity, unless the hjrperemia
passes to a state of over-powering congestion, while
the anemic state promotes rest and repair. The
-condition for sleep is that of cerebral anemia.

Now what are some of the natural causes of
sleep? What are the causes which prevent sleep,
and by what means shall the latter be removed?
The favoring causes of sleep are the darkness of
night, the removal of all disturbing agencies, the
horizontal position of the body, an easy and com-
fortable bed, cessation from toil and thought, a
sufficient nourishment to satisfy the demands of the
-entire system, and a release of the brain from sen-
sorial impressions.

Under these favoring causes the approach of sleep
is usually swift and easy. It is said that the mind
is *' pervaded by a strange confusion which amounts
almost to a mild delirium; the ideas dissolve their
•connection with the mind one by one, and its own

AND THEIR TREATMENT, 67

essence becomes so vague and diluted that it melts
away in the nothingness of slumber."

Health of body and peace of mind are the normal
conducements to sleep. Hence we find that the
young, the innocent, the healthy, and the happy are
the best and most natural sleepers.

Among the assisting causes of sleep, we may
name monotonous sounds, such as slow music, the
humming of bees, the falling of rain, the rattle of
wagons, the roll of street cars, the roar of water-
falls, the splash of the ocean surf, and, most of all,
the voice of a dull preacher who, armed with a
soporific sermon, seems to have no other aim except
to put to sleep both the pillars and the gods!
Monotonous sounds attract the attention of the
mind from inward cares or outward irritation, and
lull the senses to narcotic forgetfulness, like the
crooning voice of a motherly old nurse.

We may also note, as a sleep producer, the effect
of cold upon the system, which promotes, at first,
drowsiness, and sometimes an irresistible tendency
to sleep. And again, excessive heat tends to indolent
inactivity of the body, drowsiness of the mind, and
an inclination to doze and slumber. Alcohol, opium,
and other drugs are often sleep-compelling when
given in overmastering doses. A lymphatic tempera-
ment favors likewise the induction of sleep.

Now in considering the causes which prevent
sleep, we name :

1. Those pathological conditions of the brain
which derange the normal action of the mind. Chief
among these are hyperemia, or excessive blood sup-
ply, on the one hand, and excessive anemia, or lack
of supply, on the other.

2. Protracted overuse of the brain— that is, over-

5

58 MENTAL DISEASES

work until the strain produces, or tends to produce,
vasomotor paralysis.

3. Worry. Worry is an undue anxiety over the
common or little every-day affairs of life. It is this
everlasting worry that produces more than three-
fourths of all the mental disasters which befall the
children of men. My advice to you is to clean out the
sand of worry from the bearings of your existence,
and pour in the oil of peaceful contentment with
your lot. Then you will run the race of life easily,
without danger of friction, or overwear, or hinder-
ing hot-boxes on the baggage car of your brain.
You may work and study with great vigor during
the day, and no harm may result ; but when worry
finds its way into every recess of reason, when it
breaks the back of our better judgment, and stuns
our wills, then our brains lose their best powers, and
our trains of thought fall into abject and hopeless
ruin.

4. The natural temperament of some people is a
formidable obstacle to the acquirement of sleep.
Bilious people are apt to be melancholy. The
nervous temperament impels its owner to rapid
action, until exhaustion, irritability, and sleepless-
ness follow. Victims of an unfortunate temperament
seek matrimonial alliances with those who are
directly their opposites. The despairing and the
despondent should consort with the sunny and the
sanguine, while the irritable and excitable should
secure, if possible, mates who are lymphatic and
placid.

5. Localized disease in some portion of the body,
other than the brain, may, by reflex action, produce
sleeplessness. Thus we may have disease of the
heart, which induces wakefulness. The lungs, the

AND THEIR TREATMENT, 59

stomach, the liver, the bowels, or the genital organs
may all become, through disease and by reflex ac-
tion, centers of sleep disturbing tendencies. To cure
sleeplessness under such circumstances requires a
cure of the organs involved.

We now offer a few practical suggestions for the
induction of satisfactory sleep:

1. We should cherish, so far as possible, a philo-
sophical frame of mind. That is, we should "take
no thought for the morrow." You should impress
this philosophy upon your sleepless patients.

2. To secure sleep we must put the body in proper
condition, and this end is attained by proper toil or
exercise, by suitable diet, by careful attention to all
the excretory organs, and by polishing up the
human temple along the line suggested by the old
adage: "Cleanliness is next to godliness." He who
works and washes wisely and well rarely fails to
attain good sleep at night. Before retiring to sleep
the bladder and the bowels should be relieved ol
their contents, if necessary, otherwise they act as
localized irritants which, by reflex influence, disturb
sleep.

3. Proper nourishment of the body is essential to
the acquirement of sleep. If the brain is weak and
anemic — that is, below the health level — it must be
strengthened and nourished by appropriate nutri-
ment before good sleep can be attained. Thus it
happens that a weakly person is often made to sleep
well by drinking considerable quantities of hot milk,
or beef tea, or some mildly stimulating broth, or
soothing gruel, a short time before the hour for sleep
arrives. The hung^ nerves having been satisfied,
sleep comes easily. On the other hand, if there is a
tendency to hyperemia of the brain, and an over-

60 MENTAL DISEASES

active state of the mind, benefit is often derived from
partaking of a little plain solid food just before retir-
ing. While the stomach is busy digesting this solid
food, the brain may be relieved of engorgement to
such an extent as to admit the inception of sleep.
As a rule, in this climate, it is neither safe nor health-
fill to go to bed on an empty stomach. Of course if
a person is a dyspeptic, and subject to much pain
during the process of digestion, care should be exer-
cised as to the variety and quality of the food con-
sumed. Individual idiosyncrasies should be con-
sidered, and that food should be selected which
experience has shown to be the most agreeable and
satisfying. Try to find for each individual case the
food which most surely agrees, and try to keep your
patients away from that food which disagrees.
Sometimes if the stomach is very weak, and the
mind also, a little good old wine may be taken with
the food the last thing at night. Sometimes brandy
has a marked influence in the relief of insomnia.
Some years ago we had a woman patient who had
suffered with intense insomnia for years. We tried
various remedies without success. At length we
gave her from two to four ounces of brandy each
night on going to bed. The patient began to sleep
regularly and suflSciently, and in three months the
insomnia of years had entirely passed away. The
patient slept well, ate well, and became strong and
cheerful. As soon as the natural tendency to sleep
was restored, the brandy was stopped, but good
health and abundant sleep continued.

4. A warm bath, followed by a cold douche and
brisk rubbing, will oftentimes produce drowsiness
and ability to sleep by those who have been pressed
with cares, and who have been irritated or disturbed

AND THEIR TREATMENT, 61

during the day in body and mind. Business men
who are shut up in close offices all day, and who
work very hard with their brains, may be greatly
relieved by a quick hot and cold bath, followed by a
brisk rubbing, just before going to bed. The rubbing
should be performed by an attendant, in order to
avoid causing extra fatigue to the patient.

5. Fresh air should be supplied freely in every
sleeping-room, yet the sleeper should be protected
from even moderate draughts ; for these, if long-con-
tinued, will produce chilliness of one portion of the
body, while another portion may be over-heated,
and thus a disturbing inequality of circulation
ensues.

6. Beds should be firm in texture, level, and well-
elevated from the floor ; for thus the sleeper is above
dangerous, heavy gases. Some think it is wise to
have the head toward the north and the feet toward
the south, in order that the magnetic currents may
affect the system favorably. Bed clothing should be
light and porous as practicable. Soft woolen
blankets are best. Stiffly starched counterpanes are
objectionable, and should be removed at night, be-
cause they do not favor good ventilation.

7. The position of the head is of importance dur-
ing sleep. In cases of hyperemia the head and
shoulders should be well elevated by means of large
pillow^s. In cases of anemia, w^here the heart's
action is weak, and the blood supply is imperfect, a
very slight elevation should be granted. One small
pillow is generally enough for anemic patients.

8. Another means for inducing sleep is massage,
or muscular manipulation. This should be applied
by a trained nurse, and according to systematic
rules, as laid down by the attending physician. If

62 MENTAL DISEASES

you want to learn more about massage, read Dr. S.
Wier MitchelPs interesting work, entitled "Fat and
Blood."

We come now to the use of remedies for sleepless-
ness, and by way of episode we will give you a few
ancient prescriptions for the production of sleep.
Lemnius advises that you anoint your temples with
virgin wax at the hour of sleep. Mizaldus tells us
to rub our weary and sleepless brows with rose
water and vinegar, together with an ointment made
of nutmegs grated upon rose cake, and this to be
wet with a little woman's milk. Cardan suggests
that we smear our teeth at bed-time with ear wax
from a dog. To these may be added oil of nenuphar,
wormwood, mandrake, pillows of roses, fat of a
dormouse, swine's gall, hare's ears, violet leaves,
lovage waters, and lac virginale. It seems to me
that the application of these remedies should be left
to the tastes of the patient !

An ancient and likewise a modern and very valu-
able remedy for sleeplessness is the common lettuce
which grows in every garden. You remember that
Venus, after the death of Adonis, her lover, threw
herself upon a bed of lettuce in the back yard, and
thus gained sleep and forgetftilness of her sorrow.
Galen, one of the fathers of medicine, relates that his
own sleeplessness was relieved by eating lettuce
salad at night.

Upon the principle that a physician, especially a
homoeopathic physician (who is a physician plus a
homoeopath), cannot know too much, we present a
brief list of old school hypnotics, w^ith the doses, and
the authority for their use :

((

<(

AND THEIR TREATMENT, 63

Drug Dose Authority

Bromide of Potash, 5 grs. to i dr., S. O. L. Potter

Bromide of Soda, 5 grs. to i dr..

Bromide of Calcium, 5 grs. to i dr.,

Bromidia, i fl. dr. in water, Battle & Co. , St. Louis

Chloral, 2 to 30 or more grs.. Potter

Codeine, ^thto i gr., S. O. L. Potter, Brannan

Bromal Hydrate, i to 3 grs. , at bed-time. Dr. Steinauer

Hyoscinae Hydrobromas, yiiyth to ^^^th gr.. Potter & Dr. Lyon
Monobromide of Camphor, i to to grs. in emulsion. Potter
Morphine, ^^th to >^ gr. ,

Opium, powder, %\}Ci to 2 grs..

Opium, tincture, 2 minims to 22 drops — i gr. opium,
Paraldehyde, 30 minims to i dr., Potter & Granger

Sulfonal, 15 grs., repeated 2 to 5 hours. Granger, Seguin & Brannan
Trional, 15 to 30 grs., Henry Morris, M. D.

Probably Sulfonal is one of the most commonly
used, and perhaps one of the least harmful hypnotics
in general use among our old school brethren of to-
day. It is well to know something of these hyp-
notics, because you may be called upon to treat
patients who have been heavily dosed with them,
and you should know what to expect, and how to
antidote the effects of such drugs. In our treatment
of more than five thousand insane persons, many of
whom have suffered with insomnia, we have never
felt obliged to use old school remedies in old school
doses.

We now give a list of homeopathic remedies,
together with the officinal doses, as prescribed for
their physiological effects :

Drug Dose Authority

Avena Sativa, 5 to 30 drops, Q Dr. Trowbridge

Belladonna, i to 30 drops, Q Dr. Potter

Cannabis Indica, 5 minims to i dr., Q **

Cimicifuga, 15 minims to i dr., Q **

Coca, >^ to I dr., fluid extract, '*

64

MENTAL DISEASES

Drug

Dose

Authority

Coffea,

lo to 50 drops,

Q

Dr. Potter

Gelsemium,

10 drops to I dr.

6

(I

Hyoscyamus,

2 dr. to I oz.,

e

ii

Kali Bromide,

5 grs. to I dr.,

((

Moschus,

10 grs. med. dose,

U. S. Dispensatory

Nux Vomica,

I to 5 or 10 minims,

Dr. Potter

Passiilora,

30 to 40 drops.

e

Boericke & Tafel

Stramonium,

5 minims to % dr.,

e

Dr. Potter

Valerian,

>^ to 2 dr..

(<

Zincum Met.,

IX to 3x,

Dr. Hughes

We come now to present, as a climax, the charac-
teristic indications for a few of the most prominent
homoeopathic remedies for sleeplessness. These rem-
edies have been proved, and their symptoms have
been duly recorded. We prescribe them in accord-
ance with the ** totality of symptoms,'* and accord-
ing to the methods laid down by Samuel Hahne-
mann. The application of these homoeopathic
remedies affords, we believe, the best results in the
long run, and they leave the patient at the end of a
course of treatment without injury or damage. We
give drop doses once in from one to four hours,
according to the severity of the symptoms ; and we
use the third, sixth, twelfth, and higher potencies.
Sometimes we begin with the third decimal, and
sometimes with the third centesimal, and go up
accordingly.

Aconite. — Sleeplessness after exposure to cold
winds, and where there is a fall, strong, quick pulse,
with great restlessness, anxiety, and fear of death.
It may be used in mental anxiety caused by the
shock of bad news. (Also Gelsemium, Ignatia, and
Opium). Cases of acute melancholia with agitation,
or acute mania with great excitability, are often
relieved at the outset by the use of Aconite.

AND THEIR TREATMENT. 65

Belladonna, — Sleeplessness, with flushed face,
dilated pupils, and throbbing in the head. The
patient has horrible dreams, from which he awakens
in a fright, but he soon overcomes this fright, and
becomes hot and pugilistic.

Cbamomilla, — Sleeplessness on account of severe
pain, such as toothache. The patient is cross and
irritable, and inclined to groan and move about.
Chamomilla is both ugly and contemptible.

Cimicifuga {Actea Racemosa). — Sleeplessness after
drinking, opium eating, and great muscular exer-
tion ; after protracted watching, where there is rest-
lessness, and great tremulousness of the muscles
throughout the entire system. Pain in the base of
the brain, extending to neck and shoulders. The
mind is wrapped in the blackness of eternal dark-
ness. (Some prefer the alkaloid, Macrotin for
drunkards and opium eaters. As an antidote to the
opium habit, give Macrotin in the third decimal trit-
uration, a two-grain powder every three hours).

Coffea, — Sleeplessness from excessive mental ac-
tivity. Excessive sensitiveness to all impressions;
fidgety, and cannot compose the mind to sleep. It is
best to give Coffea in the sixth or the thirtieth
potency.

Gelsemium. — Sleeplessness from nervous irrita-
tion, or acute disorders of the nervous system. The
patient is dull and stupid, but unable to sleep. Gel-
semium is often useful in the sleeplessness of acute
alcoholics. Drop doses of the second or third decimal
is frequently effective, although sometimes the tinct-
ure is administered in two or three drop doses. You
may give Gelsemium for acute drunks, for long
drunks Nux Vomica and Cimicifuga, and for very
long drunks Opium; and when the drunk has con-

66 MENTAL DISEASED

tinned until great exhaustion, emaciation, and rest-
lessness follow, then give Arsenicum.

Hyoscyatnus, — Sleeplessness without apparent
cause. The patient is very nervous; jumps in his
sleep, and thus awakens himself. While the Hyoscy-
amus patient cannot sleep, he is nevertheless good-
natured and jolly, although inclined to talk upon
salacious subjects, and to uncover the body. Women
especially when needing Hyoscyamus take off their
clothes because they are erotic. The difference be-
tween erotomania and nymphomania is this : Eroto-
mania has great mental excitement upon sexual
subjects; nymphomania has intense physical desire
for sexual intercourse. Both are affected in body
and mind, but in the Hyoscyamus case the mental
symptoms predominate, while in the physical case
Cantharis is called for. Where the patient awakens
many times during the night, but falls asleep easily,
give Phosphorus. Hyoscyamus has a jolly delirium,
Nux Vomica has an intense crossness and irritability,
while Phosphorus is sad and solemn.

Kali Bromidum. — This is a valuable remedy for
insomnia where it is induced by the exhaustions and
irritations of long-continued disease. Large doses ot
this drug are unnecessary. We use the first decimal
trituration, giving a one or tw^o-grain dose every
hour during the evening, say, from six to eleven
o'clock. It is very effective in the sleeplessness ot
sick and wasted women.

Nux Vomica, — This is suitable for those who sleep
during the middle of the night, but awaken about
three in the morning. Such cases are usually hard
workers, and perhaps hard drinkers. Sometimes
they are studious and sad, and sometimes they are
lazy, as well as irritable. The Nux Vomica patient

k

AND THEIR TREATMENT, 67

rarely comes out of his sullen mood, except to make
trouble for others.

Stramonium, — ^The Stramonium patient is sleep-
less because he has horrible hallucinations of sight.
He sees all kinds of strange animals coming toward
him from every direction, and these apparitions pro-
duce in his mind a horrible, abject, and cowardly
fear which prevents sleep. Stramonium is often
called for in the sleeplessness of acute mania and
acute alcoholism.

Veratrum Album. — This is a remedy which assists
in the induction of sleep where the patient is suffer-
ing with acute mania, or puerperal mania, or relig-
ious excitement. There is great restlessness of the
mind, with pallor of the countenance, coldness of the
body, and tendency to collapse of all the vital forces.
The patient may be full of religious supplication, or
may dream of robbers, or of being bitten by a dog,
or of being drowned.

There are a few new remedies for sleeplessness
which are sometimes valuable, and generally harm-
less. Avena Sativa (the common oat) is useful for
the sleeplessness of those who are over-worn by hard
work until they cannot sleep. The usual dose is
fifteen or twenty drops of Avena tincture taken at
bed-time. Coca Erythroxylon is sometimes used in
neurasthenic, neuralgic, and hysterical cases. Pisidia
(the Jamaica dogwood) is another remedy which
may be used in behalf of weak, exhausted and sleep-
less patients. It is sometimes useful in the early
stage of acute mania. Passiflora Incarnata is a
remedy which has been used with success in the
sleeplessness of women who are suffering with great
stress of excitement, and who are inclined to break
away from their guardians, and to commit suicide.

68 MENTAL DISEASES

The subject of sleep is one of vast importance.
The condition of sleeplessness is so deplorable as to
stimulate not only our sympathy, but our best
eflforts for its relief. We can do this if we secure the
confidence of our clients, and then patiently and per.
severingly toil in their behalf. We should give up
over-mastering hypnotics, and use homeopathic
remedies instead. We should banish morphine from
the bedroom of the sleepless, and introduce hot milk
instead. We should remember that beyond the tem-
porary relief afforded by large doses of hypnotics, we
may find safety and efficacy in

" Many simples operative
Whose power will close the eye of anguish."

That was a wise injunction of Meander when he
declared that ** sleep is the natural cure of all dis-
eases.'* To be so, however, it must be induced by
mild, and not by savage measures. "Let us, then,
cultivate sleep— not the sleep of sloth and inertia,
not the listless revery of ennui, not the keff of the
Arab or the noonday siesta of the tropics, but that
other and nobler Somnus, whose temple, opening
only at nightfall, invites the weary, day-worn
traveler to rest. Here, with the silent stars for his
everlasting ministers, he sits enthroned in halls of
sweet obliviousness, waiting with the lavish and im-
partial affection of a parent, to crown us all with
the poppy wreaths of sleep."

LECTURE IV

HISTORY AND CLASSIFICATION OF INSANITY

Theories, Definitions, and Forms of

Commitment

We shall speak to-day, very briefly, of the history
of insanity, and also give some classifications of this
disease, together with theories and definitions.
Again, we shall speak of the legal forms of commit-
ment to hospitals for the care of the insane, and ad-
vise you when to commit and when to refi"ain from
so doing.

The earliest reference to insanity is found in the
book of Deuteronomy. There the Lord, through
Moses, makes promises to those who are good, and
and threats against those who are bad ; and among
other visitations we note: **So thou shalt be mad
for the sight of thine eyes which thou shalt see.''
Again, we find in Samuel, concerning David: "And
he changed his behaviour before them and feigned
himself mad in their hands, and scrabbled on the
door-posts of the gate, and let his spittle fall down
upon his beard.'' That was a cunning and success-
ful feigning of insanity. Feigning insanity, under
distressing circumstances, has been one of the
achievements of mankind throughout the centuries.
Again, in Ecclesiastes : "I said of laughter, it is
mad ; and of mirth, what doeth it ? " This is a fair
description of the condition known as dementia.
The preacher also says : " Surely oppression maketh

70 MENTAL DISEASES

a wise man mad/* Here is another ancient but
eternal truth, for oppression, if long-continued, is a
-well-known cause of insanity. Jeremiah declares,
concerning the wine cup : '* And they shall drink and
be moved and be mad.*' And concerning religious
matters, he says: "For every man that is mad and
maketh himself a prophet, that thou shouldst put
him in prison, and in the stocks.'' And once more:
**They are mad upon their idols." In these state-
ments of priest, prophet, and psalmist, we learn
something of the causes and conditions of insanity.
Not only individuals but nations were poisoned
by the wine cup in ancient times, for Jeremiah also
says : "Babylon has been a golden cup in the Lord's
hands, that made all the earth drunken. The
nations have drunken of her wine, therefore the
nations are mad." It is a universal fact that unwise
and intemperate use of any of the blessings of life
brings inevitable retribution. On the other hand,
the temperate enjoyment of those things which the
Creator has made possible is the best way to live.

Greek w^riters speak of cases of mental aberration
as occurring with some frequency in Greece. The in-
habitants of the Roman Empire, from the crazy king
Nero to the humblest citizen, were afflicted with
mental unsoundness; and in ancient Egypt we find
that the Egyptians had temples and priests for the
care of the insane.

Hippocrates, who flourished about four hundred
years before Christ, w^as the first physician w^ho
seemed to have any true conception of the real
nature of insanity. He believed that to a certain
extent insanity was due to physical disturbances,
and yet for many centuries later the masses believed
that madness was simply a visitation of the devil.

AND THEIR TREATMENT. 71

In the time of Christ the insane were permitted to
w^ander at large among the woods and in the caves
of Palestine. Six centuries after Christ, the monks
of Jerusalem built the first hospital or asylum for the
care of the insane. A century later the fame of St.
Dymphna had extended over Europe, from the little
village of Gheel, in Belgium, and those afflicted with
mental diseases were taken to her shrine for the
purpose of being cured.

You will remember that St. Dymphna was an
Irish princess who resisted the assaults of an un-
natural father, and fled to Belgium, where she
engaged herself in the care of the sick. Her father
pursued her, and found her, and cut off* her head in
one of the streets of Gheel. Two insane persons saw
the blood gush from her neck, and the shock immedi-
ately cured them of their insanity. From that time
on St. Dymphna became the patron saint of mental
invalids, and the example of her purity of life has
been an invisible but potent power for the restora-
tion of the insane from that day to this.

In the year 1409 a hospital for the insane was
established at Valencia, in Spain. In the year 1547,
the hospital of Saint Mary of Bethlehem was estab-
lished near London. This institution was known as
** Bedlam '* for a long time, a name notorious in the
history of London.

The first asylum established upon reform princi-
ples was St. Luke's in London. This was founded in
1751. About the year 1791, Samuel Hahnemann,
the expounder of homeopathy, established an
asylum for the insane at Georgenthal, near Gotha>
and in this institution the law of kindness was the
unvarying rule. Hahnemann, in his ** Lesser Writ-
ings," says: **I never allow any insane persons to

72 MENTAL DISEASES

be punished by blows or other corporeal infliction."
About 1792 or '93, Pinel struck the chains from the
incarcerated insane at the BicStre, near Paris.

During the past century there has been a gradual
tendency toward better things in behalf of those af-
flicted with mental disease. A hundred years ago
they were treated with prison surroundings and
prison fare. Then asylum treatment began to pre-
vail. This is a higher grade of treatment than that
bestowed by the prison. Asylum care means close
confinement, good food, sufficient clothing, and com-
fortable beds. Asylum care means the humane
custody of dangerous prisoners. From the asylum
we move on to the hospital system of caring for the
insane. The hospital system recognizes the fact that
the lunatic is a sick man, and needs nursing and
medical treatment in order to effect a cure. Hospital
treatment has been gradually introduced during the
past twenty years or more, and in time it will even-
tually supercede asylum treatment, and prison or
workhouse methods in the management of the
insane everywhere.

Classification of Insanity

We come now to a classification of insanity.
Many classifications have been made. We wish to
present to you that which is as brief and simple as
possible, hence we make the list as follows :

1. Melancholia, which includes all forms of mental
depression,

2. Mania, which includes all forms of mental ex-
citement,

3. Dementia, which includes all forms of mental
weakness or failure, except idiocy and imbecility,

4. General paresis, which is a distinct form of

AND THEIR TREATMENT.

73

mental disease possessing certain characteristics
^which demand that it shall be classified separately.
In general paresis you will find conditions of mental
depression, mental excitement, and mental weak-
ness ; and in the course of this fatal disease you will
find that it embodies and embraces some elements of
all other forms of insanity.

We present herewith two classifications. One is
known as the British classification, and the other
as the American classification.

British Classification

I. Congenital, or infantile mental deficiency.
Idiocy; Imbecility; Cretinism: (a) With epilepsy;
(6) Without epilepsy.

II. Epilepsy acquired

ill. General Paralysis of the Insane

Acute
Chronic
Recurrent

A potu, or mania of drunken-
ness
Puerperal
Senile

Acute

Chronic

Recurrent

Puerperal

Senile

Primary
Secondary
Senile

Organic, i. e., from tumors,
hemorrhages, etc.

IV. Mania ^

Y. Melancholia... h

VI. Dementia ^

74

MENTAL DISEASES

I. Mania >.... ^

II. Melancholia... -

VII. Delusional Insanity (Monomania)
VIII. Moral Insanity

American Classification

Acute
Chronic
Recurrent
Puerperal

Acute
Chronic
Recurrent
Puerperal

III. Primary Delusional Insanity, Monomania,
Subacute Mania (Paranoia?)

' Primary
Secondary
Senile

Organic (tumors, hemor-
rhages, etc.)

V. General Paralysis of the Insane (General
Paresis)

VI. Epilepsy (with Mania or Dementia)

VII. Toxic Insanity (Alcoholism, Morphinism,
etc.)

VIII. Congenital or subsequent mental \ ^ t^-vj.

deficiency \^ ^. . ^

•^ V Cretmism

These classifications are somewhat more elabo-
rate than the one which I have presented to you,
and perhaps this elaboration is necessary in making
up an extensive work upon the subject. They are

IV. Dementia <

AND THEIR TREATMENT, 76

probably serviceable to alienists, but for the general
practitioner it may be well to get firmly fixed in
mind the four general divisions of insanity — ^namely,
melancholia, mania, dementia, and general paresis, —
and hold to them as starting points for wider study
and further investigation.

Theories

There are three theories concerning the nature of
insanity :

1. The ancients believed that insanity was a pos-
session of the devil, — a perversion of the psychical
forces through the eflfects of sin or crime.

2. It is believed by some that insanity is a disease
of both body and mind, or that the physical and
spiritual forces are both degenerated when under the
influence of insanity. If the spiritual forces are im-
mortal, they can never become diseased.

3. The last and most modem theory is, that in-
sanity is a departure from the normal mental status,
as a result of diseased conditions of the brain. In
other words, insanity is a physical disease, or, at
least, all mental aberrations are dependent upon
either functional or organic diseases of the brain and
nervous system. These conditions of the brain are
due, we believe, to disordered blood. The blood is
always perverted in insanity. It is either too thin
or too thick, and its quality and distribution have
been impaired before diseased conditions of the brain
are likely to occur.

For general purposes, it is well to remember that
the ancients thought insanity to be a diseased condi-
tion of the soul, while modern alienists believe that
insanity is due to a physical disorder. Between
these two extremes there may be many shades of be

76 MENTAL DISEASES

lief, but it is unnecessary to touch upon them at this
time. It is essential for the cure of insanity that its
physical nature should be recognized, in order that
we may deal with it just as we do with any other
physical disease. If you can convert a diseased
brain and a diseased body into a sound and healthy
brain and body, then you will be likely to have a
sound mind as the occupant of the healthy human
temple.

Definitions

Dr. Andrew Combe declares insanity to be a
*' prolonged departure, without an adequate ex-
ternal cause, from the states of feeling and modes of
thinking usual to the individual when in health.
This is the true feature of disorder in mind." A
general definition of mental disorder is this: In-
sanity is a departure from the normal mental status
of the individual, and this departure is due to some
diseased condition of the brain or nervous system.
Of course there may be temporary departures from
the normal mental status, as when an individual
gets drunk, and becomes hilarious, or delirious, or
besotted, or stupid. But that condition passes
away as soon as its cause evaporates, which is
usually in a few hours. Then, too, there may be dis-
eased conditions of the brain which do not disturb
the serenity and stability of the mind — ^that is, some
minds are so strong that they hold themselves in
proper poise even when the home of that mind (the
brain) is in a disordered state.

From a medical standpoint, insanity means
mental aberration due to a diseased condition of the
brain. From a legal standpoint, insanity means
mental unsoundness developed to such a degree that

AND THEIR TREATMENT, 77

the victim is relieved from responsibility in case he
should commit a crime. Or the mental disorder is
carried to such an extent that the afficted person
cannot assume responsibility, or perform the ordi-
nary duties of life, such as the making of a will, the
conveying of property, the contracting of debts, or
the incurrence of the solemn obligations of matri-
mony.

Thus you will see that insanity from a medi-
cal standpoint and insanity from a legal stand-
point diflfer mainly in degree. A person suffering
with simple melancholia might be considered insane
and in need of medical treatment, while at the same
time this person could exercise judgment, assume re-
sponsibility, and perform the ordinary duties of life.
But when insanity has developed to such an extent
that self-control is lost, or greatly impaired, and
judgment and will are seriously disturbed, or re-
duced in action, then the person is insane from a
legal standpoint.

Some of the principal words used in the nomen-
clature of insanity are delusion, hallucination, and
illusion.

A delusion is a false belief. There are both sane
and insane delusions. A sane delusion is a false belief
which comes as a result of imperfect education. A
child may be taught to believe in Santa Claus, and
he may actually put all his faith in that supposed
individual. But this false belief in Santa Claus is a
sane and harmless delusion. It is a delusion which
the child outgrows when he gets a little further on
in life. An insane delusion is a false belief independ-
ent of education or teaching, and it springs from a
diseased condition of the brain. If a man becomes
sleepless, restless, and expansive in his ideas by

78 MENTAL DISEASES

reason of an inflammatory condition of the brain,
and while actually poor he comes to think of himself
as worth a hundred millions of dollars, he is said to
have an insane delusion.

We will now proceed to the consideration of de-
lusions in their relations to positive insanity. These
delusions are multitudinous in number, and of the
most diverse and opposite character. They sweep
the gamut of demoralized human passion. They fill
the cup of their possessor with the gall of intensest
sorrow, or they cause it to overflow with perpetual
joy. They conjure up the gloomiest forebodings of
future ills, or they arch the troubled sky of the de-
sponding with a rainbo\sr of ecstatic hope. They
plunge their victim into deepest hell of despair, or
they bear him aloft to some heavenly elysium. Such
are the diverse emotions and pathways of those
who are given over to the balefiil influences of insane
delusions.

Man^s natural course is of an even tenor, and
w^hatever produces undue exaltation or depression
tends to the dethronement of human reason. A
natural division of delusions may, therefore, be made
under two heads, — namely, delusions made manifest
by mental exaltation, and delusions which grow out
of or are the effects of profound mental depression.
In the former case incoherency of thought and con-
stant change of ideas are quite common. In the
latter a steady and fixed contemplation of a single
idea is noticeable. In either case the cause of
delusion rests in some abnormal condition of the
brain. The most marked delusions are those of the
general paretic, whose tendencies to ideas of
grandeur and exhaustless wealth are well-known.
In these cases there are changes in the membranes

AND THEIR TREATMENT, 79

and cortex of the brain. Inflammatory adhesions
are usually found upon the surfaces of the anterior
and middle lobes of the brain in the paretic. In
mania, where the delusions are remarkably kaleido-
scopic in their manifestations, there is usually an in-
flammatory condition of the blood vessels them-
selves, which conditions, often varying, may account
for the marvelous variations of mental action and
the development of protean-hued delusions. In
melancholia there is a greater fixedness of mental
aberration than in mania, and there is also greater
uniformity of pathological change, the usual condi-
tion of the brain in melancholia being that of pass-
ive venous congestion.

Delusions may result from a diseased condition of
the brain, produced by either internal or external
impressions. For instance, as a result of disease
located primarily in the lungs, the heart, the liver,
the stomach, the kidneys, or the bowels, the brain
may be so impressed by reflex action that the victim
comes to believe that he is on fire, that he is made of
glass, that he has an animal in his abdomen, or that
he is possessed by the devil. On the other hand, a
person may receive an unpleasant impression from
the sight of some horrible object, or from some
action on the part of those around him, and such
impression, developing an irritation of the brain,
may come to produce at first a false conception of
fact, and finally a delusion that he is being pursued,
or poisoned, or injured, or robbed, or slandered. In
the same way these impressions may stimulate the
faculties of imagination and hope until the patient
concludes that he is the possessor of boundless
wealth, or holds sway undisputedly over the realms
of imaginary empire.

80 MENTAL DISEASES

An hallucination is **a sensation without an ob-
ject," according to M. Ball, of Paris. Thus it is said
that an individual who hears voices when no sound
strikes the ear has an hallucination. Hallucina-
tions, to speak plainly, are false perceptions through
any one of the senses. There are hallucinations of
hearing, of sight, of smell, of taste, and of feeling.

Hallucinations are of two varieties: (1) Those
which indicate a temporary and unimportant dis-
eased condition of the brain, as, for instance, visions
and nightmare, particularly in the young; and, (2)
those which indicate profound mental aberration.
As a result of a simple congestion, a person may see
two objects on the wall where but one exists ; or he
may see stars or rings floating in the air, or angels
in the sky. As the result of a drinking bout, a person
may see snakes, or black dogs, or vermin. The same
effects may be produced temporarily by such drugs
as Belladonna, Stramonium, or Cannabis Indica.

Harmless hallucinations are temporary in their
nature, and the victim may often be brought to
realize their falsity. Hallucinations indicating in-
sanity are fixed, permanent, and intractable in their
nature. The insane man constantly reiterates what
he supposes to be a fact, that he sees animals or
objects, or that he hears voices, and no amount of
argument or ocular demonstration will relieve his
mind from the erroneous conclusions which he
draws from these false perceptions. Sometimes a
patient wU temporarily deny that he is troubled
with hallucinations, but this denial is generally of
short duration.

Now it often happens that delusions spring up in
the mind as a result of hallucinations. Hallucina-
tions affect the sensory motor gangha. Delusions

AND THEIR TREATMENT. 81

find their home in the inhibitory motor centers, or
centers held in check by the influence of other nerve
centers. As in the ordinary action of the brain, -we
first receive impressions and then perceptions, and
form conclusions and judgments by the transmission
of these impressions from one set of brain cells to
another, so among the insane these false perceptions
make their impress upon the primary sensory gang-
lia, and finally transmit these impressions to the
ideational centers. The natural result of these im-
pressions is a false judgment of external things, and
hence a false belief. And as a natural sequence of
these false beliefs, we have that unnatural speech or
action which indicates insanity, or a departure from
the normal mental status of the individual.

It is generally considered among alienists that
the presence of hallucinations in a case of insanity is
an unfavorable symptom. The reason for this, we
believe, lies in the fact that those portions of the
brain which have been most thoroughly developed
by constant use, and which are therefore the strong-
est, have become diseased. The ideational centers
may remain dormant and inactive from lack of use,
but those centres which receive impressions of ex-,
temal things through the senses are always, from
the very nature of the things, subjected to steady
and persistent toil ; consequently they become hard-
ened by use, like the brawn of the blacksmith, and
are therefore enabled to resist the ordinary attacks
of disease. Hence, when these strongholds of brain
power are broken down by overuse, and their best
forces are scattered by the blinding storm of in-
sanity, their rebuilding becomes a matter of grave
and protracted doubt.

Physically speaking, hallucinations are due to

J I

82 MENTAL DISEASES

imperfect, or insufficient, or changed, or defective
nutrition of the brain substance. They may arise
from congestion, from anemia or from atheroma-
tous condition of the vessels, which latter may pro-
duce an irregular blood supply.

**It is a singular fact,*' says Blandford, "that a
person who is blind, either from disease of the ex-
ternal organ or the internal sensory ganglia, may
yet see with the mind's eye, and reproduce in memory
the appearance of objects which he has stowed away.
Now we may suppose that in case of an hallucina-
tion, the internal organ is excited not from without,
as ordinarily happens, but downwards from the ide-
ational portion of the brain. Accustomed, however,
as he is to connect all the sensations experienced with
the external organ and the external world, the
patient fails to perceive, sometimes at any rate, that
the excitation is from within, and is firmly im-
pressed with the belief that the sight, which the
organ of sight apparently sees, and the voice he
apparently hears, comes from without and not from
within. The idea strikes his sensory ganglia so for-
cibly that the shadow becomes a reality, which per-
chance may not be removable by demonstration or
argument.'' In the main, we think this idea of the
learned doctor is correct. We have had under our
charge several blind people, whose blindness was
acquired. These have been insane, and have ex-
perienced hallucinations of sight. We have known
deaf people to be troubled with hallucinations of
hearing. But we have never known a person who
was bom blind or deaf to be afflicted with hallucina-
tions of sight or hearing. It seems, therefore, neces-
sary, in order that the ideational centers may pro-
duce a conception of external objects or sounds, that

AND THEIR TREATMENT, 83

they shall first have been the recipients of similar
conceptions through external impressions.

As we have already stated, persons suffering with
hallucinations do not readily recover. We may
state, however, that hallucinations of sight among
those suffering from acute insanity do not preclude
recovery. Hallucinations of hearing are considered
more unfavorable than those of seeing. Even here,
however, we may not pronounce an utterly unfavor-
able prognosis. Other conditions are to be con-
sidered in our final judgment of the case.

Hallucinations of taste are usually very persistent.
One of our patients has for several years had an hal-
lucination that her tongue is covered with ink or
blood. Upon this symptom we gave an unfavorable
prognosis, and time has too sadly proven the cer-
tainty and the validity of that opinion.

Hallucinations of feeling are, fortunately, quite
uncommon. When once established, however, their
victims rarely yield them up. One patient thinks
that she is turning into bone ; another that he has a
child in his abdomen; another that her heart and
lungs are being cut out; while still another feels
kerosene trickling down the back, and thinks that
somebody is setting fire to it. These are all hal-
lucinations of feeling which breed fixed and perma-
nent delusions.

An illusion is a mistaken perception. The victim
may see a ball rolling on the floor, and may fancy
that it is an animal coming to destroy him. A
person may hear the sighing of the wind, and believe
that he hears angels singing to him, or demons
threatening him with some dire disorder. These are
illusions. They partake somewhat of the character
of hallucinations, but are still more closely allied to

84 MENTAL DISEASES

delusions. The latter is a false belief relating to
some physical, or mental, or spiritual fact— that is,
relating to some of the ordinary experiences or
phenomena of life,— while the former also relate to
some material existence whose qualities or attri-
butes are mistaken by the beholder.

Like an hallucination, an illusion may be of
temporary or transient nature ; or, if prolonged, the
patient may still be convinced of its falseness, in
which case these spectral sights produce no marked
change in the conduct or habits of thought of the
individual. It is a blessed fact that visions strange
may rise up before us, yet fail to frighten us from the
path of sanity ; and it is also a consoling truth that
"thoughts impure may pass through minds of
angels and of men, and leave no stain.'' In the case
of man, this results because the brain is healthy. It
is only when the hot iron of disease has seared and
scorched the brain to its depths, that the mind is dis-
torted in all its workings ; and it is then only that
delusions, and hallucinations, and illusions creep like
shadowy ghosts into the dilapidated and ruined
chambers of the soul, and refuse to be exorcised by
the wand of modem science.

Mental unsoundness is designated by several
terms. The victims of this unsoundness are called in-
sane; they are called lunatics because it was once
supposed that the moon affected the insane ; they are
called crazy because the term signifies an unnatural
degree of mental excitement. When speaking of the
insane in their presence, you should never use any of
these old-fashioned terms, but you should speak of
them as mental invalids, suffering with distresses of
the mind. Such persons demand as much tender

AND THEIR TREATMENT, 85

care and kindly sympathy as do those who suffer
with physical pain.

Requirements for Legal Commitment

The requirements for a legal commitment to a
hospital for the insane in the State of New York are
as follows :

* ** A person alleged to be insane, and who is not in
confinement on a criminal charge, may be committed
to and confined in an institution for the custody and
treatment of the insane upon an order made by a
judge of a court of record of the city or county, or a
justice of the supreme court of the judicial district, in
which the alleged insane person resides or may be,
adjudging such person to be insane, upon a certifi-
cate of lunacy made by two quahfied medical ex-
aminers in lunacy, accompanied by a verified peti-
tion therefor, or upon such certificate and petition,
and after a hearing to determine such question, as
provided in this article. The commission shall pre-
scribe and famish blanks for such certificates and
petitions, which shall be made only upon such
blanks. An insane person shall be committed only
to a state hospital, a duly licensed institution for the
insane, or the Matteawan State Hospital, or to the
care and custody of a relative or committee, as here-
inafter provided. No idiot shall be committed to or
confined in a state hospital. But any epileptic or
feeble-minded person becoming insane may be com-
mitted as an insane person to a state hospital for
custody and treatment therein.

"The certificate of lunacy must show that such

64.

Chap. 545, Laws of 1896, Art. 3, sections 60, 61, 62, 63, and

86 MENTAL DISEASES

person is insane and must be made by two reputable
physicians, graduates of an incorporated medical
college, who have been in the actual practice of their
profession at least three years, and have filed with
the commissioner a certified copy of the certificate of
a judge of a court of record, showing such qualifica-
tions in accordance with forms prescribed by the
commission.

'*Such physicians shall jointly make a final ex-
amination of the person alleged to be insane within
ten days next before the granting of the order. The
date of the certificate of lunacy shall be the date of
such joint examination. Such certificate of lunacy
shall be in the form prescribed by the commission,
and shall contain the facts and circumstances upon
which the judgment of the physicians is based, and
show that the condition of the person examined is
such as to require care and treatment in an institu-
tion for the care, custody and treatment of the
insane.

** Neither of such physicians shall be a relative of
the person applying for the order or of the person
alleged to be insane, or a manager, superintendent,
proprietor, officer, stockholder, or have any pe-
cuniary interest, directly or indirectly, or be an at-
tending physician in the institution to which it is
proposed to commit such person.

"Any person with whom an alleged insane per-
son may reside or at whose house he may be, or the
father or mother, husband or wife, brother or sister,
or the child of any such person, and any overseer of
the poor of the town, and superintendent of the poor
of the county in which any such person may be, may
apply for such order, by presenting a verified peti-
tion containing a statement of the facts upon which

AND THEIR TREATMENT, 87

the allegation of insanity is based, and because of
which the application for the order is made. Such
petition shall be accompanied by the certificate of
lunacy of the medical examiners, as prescribed in the
preceding section. Notice of such application shall
be served personally, at least one day before making
such application, upon the person alleged to be in-
sane, and if made by an overseer or superintendent
of the poor, also upon the husband or wife, father or
mother or next of kin of such alleged insane person,
if there be any such known to be residing within the
county, and, if not, upon the person w^ith whom such
alleged insane person may reside, or at whose house
he may be. The judge to whom the application is to
be made may dispense with such personal service, or
may direct substituted service to be made upon some
person to be designated by him. He shall state in a
certificate to be attached to the petition his reason
for dispensing with personal service of such notice,
and if substituted service is directed the name of the
person to be served therewith.

**The judge to whom such application is made
may, if no demand is made for a hearing in behalf of
the alleged insane person, proceed forthwith to deter-
mine the question of insanity, and if satisfied that
the alleged insane person is insane may immediately
issue an order for the commitment of such person to
an institution for the custody and treatment of the
insane. If, however, it appears that such insane per-
son is harmless and his relatives or a committee of
his person are willing and able to properly care for
him, at some place other than such institution, upon
their written consent the judge may order that he
be placed in the care and custody of such relatives or
such committee. Such judge may, in his discretion,

i

88 MENTAL DISEASES

require other proofs in addition to the petition and
certificate of the medical examiners.

"Upon the demand of any relative or near friend
in behalf of such alleged insane person, the judge
shall, or he may upon his own motion, issue an
order directing the hearing of such application before
him at a time not more than five days from the date
of such order, which shall be served upon the parties
interested in the application and upon such other
persons as the judge, in his discretion, may name.
Upon such day, or upon such other day, to which
the proceeding shall be regularly adjourned, he shall
hear the testimony introduced by the parties and
examine the alleged insane person if deemed advis-
able, in or out of court, and render a decision in
writing as to such a person's insanity. If it be
determined that such person is insane, the judge
shall forthwith issue his order committing him to an
institution for the custody and treatment of the
insane, or make such other order as is provided in
this section. If such judge cannot hear the applica-
tion he may, in his order directing the hearing, name
some referee, who shall hear the testimony, and
report the same forthwith, with his opinion thereon,
to such judge, who shall, if satisfied with such
report, render his decision accordingly. If the com-
mitment be made to a state hospital, the order shall
be accompanied by a written statement of the judge
as to the financial condition of the insane person and
of the persons legally liable for his maintenance as
far as can be ascertained. The superintendent of
such state hospital shall be immediately notified of
8uch commitment, and he shall, at once, make pro-
visions for the transfer of such insane person to such
hospital.

AND THEIR TREATMENT, 89

**The petition of the applicant, the certificate in
lunacy of the medical examiners, the order directing
a farther hearing as provided in this section, if one
be issued, and the decision of the judge or referee,
and the order of commitment shall be presented at
the time of the commitment to the superintendent or
person in charge of the institution to which the
insane person is committed, and verbatim copies
shall be forwarded by such superintendent or person
in charge and filed in the office of the state commis-
sion in lunacy. The relative, or committee, to
whose care and custody any insane person is com-
mitted, shall forthwith file the petition, certificate,
and order, in the office of the clerk of the county
where such order is made, and transmit a certified
copy of such papers to the commission in lunacy,
and procure and retain another such certified copy.

**The superintendent or person in charge of any
institution for the care and treatment of the insane
may refuse to receive any person upon any such
order, if the papers required to be presented shall not
comply with the provisions of this section, or if, in
his judgment, such person is not insane within the
meaning of this statute, or, if received, such person
may be discharged by the commission. No person
shall be admitted to any such institution under such
order after the expiration of five days firom and in-
clusive of the date thereof.

**If a person ordered to be committed, pursuant
to this chapter, or any friend in his behalf, is dissat-
isfied with the final order of a judge or justice com-
mitting him, he may, within ten days after the mak-
ing of such order, appeal therefrom to a justice of the
supreme court other than the justice making the

order, who shall cause a jury to be summoned as in

7

90 MENTAL DISEASES

case of proceedings for the appointment of a com-
mittee for an insane person, and shall try the ques-
tion of such insanity in the same manner as in pro-
ceedings for the appointment of a committee. Before
such appeal shall be heard, such person shall make a
deposit or give a bond, to be approved by a justice
of the supreme court, for the pa3nnent of the costs of
the appeal, if the order of commitment is sustained.
If the verdict of the jury be that such person is in-
sane, the justice shall certify that fact and make an
order of commitment as upon the original hearing.
Such order shall be presented, at the time of the com-
mitment of such insane person, to the superintendent
or person in charge of the institution to which the
insane person is committed, and a copy thereof shall
be forwarded to the commission by such superin-
tendent or person in charge and filed in the office
thereof. Proceedings under the order shall not be
stayed pending an appeal therefrom, except upon an
order of a justice of the supreme court, and made
upon a notice, and after a hearing, with provisions
made therein for such temporary care and treatment
of the alleged insane person as may be deemed neces-
sary.

"If a judge shall refuse to grant an application
for an order of commitment of an insane person,
proved to be dangerous to himself or others, if at
large, he shall state his reasons for such refusal in
writing, and any person aggrieved thereby may ap-
peal therefrom in the same manner and under like
conditions as from an order of commitment.

"The costs necessarily incurred in determining
the question of the insanity of a poor or indigent
person and in securing his admission into a state
hospital, and the expense of providing proper cloth-

AND THEIR TREATMENT, 91

ing for such person, in accordance with the rules
and regulations adopted by the commission, shall be
a charge upon the town, city or county securing the
commitment. Such costs shall include the fees al-
lowed by the judge or justice ordering the commit-
. ment to the medical examiners. If the person sought
to be committed is not a poor or indigent person, the
costs of the proceedings to determine his insanity
and to secure his commitment, as provided in this
article, shall be a charge upon his estate, or shall be
paid by the persons legally liable for his mainte-
nance. If in such proceedings, the alleged insane
person is determined not to be insane, the judge or
justice may, in his discretion, charge the costs of the
proceedings to the person making the application
for an order of commitment, and judgment may be
entered for the amount thereof and enforced by ex-
ecution against such person.'*

We see from the foregoing that in order to effect a
legal commitment, the following requirements of
law must be complied with :

1. A petition.

2. Personal service.

3. Examination by two qualified medical ex-
aminers in lunacy.

4. Judicial order of commitment by a judge of a
court of record.

5. Statement of financial condition of patient.
Blank forms of commitment, together with initial

history blanks, are famished by the hospital when
so desired and deemed necessary.

All town, county or city authorities before send-
ing a patient to a hospital must see that said
patient is in a state of bodily cleanliness, and pro-
vided with new clothing throughout, including shoes

92 MENTAL DISEASES

and hat. Between the months of November and
April, both inclusive, there shall be provided, in ad-
dition to the foregoing, a suitable overcoat for male
patients and a suitable shawl or cloak for female
patients ; also gloves or mittens.

I have given you the method of commitment. A
very important question may arise in your practice
as to whether or not a given insane person should
be sent to a hospital. The rule you should adopt is
this: You should send to a hospital, in the early
stages of his disease, an insane person who is
dangerous to himself or others. That is, you should
send a person to a hospital who is likely to commit
suicide or homicide, or who might, under the in-
fluence of his insanity, destroy valuable property, or
endanger or greatly distress others by his excite-
ment, and his unnatural speech or action. You
should send acute or curable cases to a hospital for
treatment when it is quite certain that the patient's
chances for recovery are improved by such pro-
cedure.

You should refrain from sending persons to a
hospital for the insane :

. 1. When the patients are very old and feeble, and
cannot do much damage at home.

2. When the patients are young or middle-aged,
but so very weak that their lives would be en-
danged by transportation from their homes to the
hospital. Such cases should be kept at home until
they are sufficiently strong to endure the fatigues
of the journey. It sometimes happens that very
weak persons are so excited by the journey to a
hospital that they die soon after being admitted. A
patient was brought to us after a journey of over

AND THEIR TREATMENT. 93

two hundred and fifty miles, and he lived less than
fifteen minutes after reaching the hospital.

3. Those who are not likely to be cured or bene-
fited by treatment, and who are easily cared for at
home. There are patients suflFering from imbecility
or dementia who can be readily cared for by their
fi^ends, and who, if sent to a hospital, would exert
a depressing and injurious influence upon patients
already received, and who may perhaps be restored
to health.

LECTURE V

MELANCHOLIA

We shall speak to-day of that form of insanity
known as Melancholia. The term melancholia is
from the Greek /xcAas, ** black/' and x^H " bile.*' The
name is founded upon the theory of a humoral pa-
thology, the four humors, according to the ancients,
being blood, phlegm, yellow bile, and black bile.
Guislain gives as a synonym of melancholia the term
Phrenalgia, ** brain pain;'' Rush, Tristimania, "sad
mania;" Esquirol, Ljrpemania, from Xvttcoj, "to make
sad."

Melancholia is a disease characterized by great
mental depression. It is an abnormality of mind to
which all humanity is at times subject. It is a grim
spectre of despair which enters every theatre of
mental activity to molest and disturb. We meet it
on the threshold of life, and through all our joumey-
ings it hovers over us.

Some of the sons of men are melancholy by nature.
They have bilious temperaments ; they look upon the
sunniest experiences of life through green and yellow
goggles, and if such men make a feeble eflfort to
escape from the spirit of melancholy she seizes upon
them with renewed vigor, and in reply to all plead-
ings for freedom and happiness she echoes in their
ears the cry of Poe's Raven — "nevermore."

"Melancholia," says Maudsley, "is a deep painftil
feeling of profound depression and misery — a great
mental suffering. The patient's feelings of external

MENTAL DISEASES AND TREA TMENT, 95

objects and events are perverted, so that he com-
plains of being strangely and unnaturally changed.
Impressions which should rightly be agreeable or
only indifferent are felt as painful. Friends and
relatives are regarded with sorrow or aversion, and
their attentions with suspicions. He feels himself
entirely isolated, and can take no interest in his
affairs, and either shuns society and seeks solitude,
lying in bed, unwilling to exert himself, or he utters
his agony in sounds ranging from the moan of dull
ache to the shrill cry of anguish, or in ceaseless gest-
ures of misery, or even in some convulsive act of
desperate violence.*'

Causes

The causes which impel the inception and onset of
this dread disorder are almost as numerous as the
experiences of life. Still we may name among the
prominent causes of melancholia the following :

1. Predisposition.

2. Physical disease.

3. Dissipation.

4. Work and worry.

5. Shock from sudden loss of friends or fortune.

6. Brooding.

7. Disorders of faith.

Predisposition. — Predisposition is an unnatural,
inborn, inherited tendency to look upon the dark
side of life ; to make the worst of everything ; to con-
jure up horrors that may never exist; to cross
bridges before they are reached ; to imagine that an
enemy lurks behind every tree and stone, and that
even tried and true friends are not always to be
trusted.

96 MENTAL DISEASES

Physical Disease. — One of the most common excit-
ing causes of insanity is physical disease at or after
the period of maturity. Whatever tends to deplete
and exhaust the physical system tends to the produc-
tion of insanity. Physical disease is produced by
various influences, but chiefly by the reckless extrav-
agance of the young in making undue drafts, either
by toil or pleasure, upon the natural resources of the
system. To be rich, to be great, to be honored, and
to be loved are ambitions which fill the American
heart. And the over-zealous struggle for these
prizes tends to the production of those physical
diseases which culminate in insanity.

It frequently happens that the victims of long-con-
tinued physical disease become depressed. This may
be the result of pain, or weakness, or exhaustion, or
a feeling of helplessness, and loss of usefulness. The
disease known as the grip especially exhausts the
nervous system, and causes profound mental depres-
sion. Again, those who suffer with non-limited dis-
eases are apt to formulate the idea that they will
never recover, and thus they become depressed. It is
well to remember, likewise, that a healthy person
may experience a shock upon his nervous system thr-
ough losses of some kind, and then become the victim
of physical disease. At any rate, you generally find
that patients suffering with melancholia are weaker
than when in health, and that all the functions of the
body are sluggish in their action. The bowels are
constipated, the kidneys are inactive, the respiration
is labored and incomplete, and the heart's action is
apt to be slow. The blood is imperfectly purified,
and a general venous stagnation ensues. The skin
becomes dry, and greatly impaired in fiinction. The
bile is not properly eliminated, and the face presents a

AND THEIR TREATMENT. 97

yellow and sallow appearance. Coupled with this
physical inactivity, we find, most naturally, a slow
and painful working of the mind itself as a result of
physical disease.

Dissipation. — By this we mean that excessive
drinking, or excessive eating, or excessive exhaus-
tion of the sexual system, either by natural or un-
natural means, not infrequently results in a culmi-
nating attack of melancholia. At the end of a long
drunken debauch, a man often feels such compunc-
tions of conscience that he is driven into an attack
of suicidal melancholia. Hence you read of numer-
ous cases where a drunken spree is ended by self-
shooting, or hanging, or poisoning.

Work and Worry. — Who can calculate the
dangers that spring from the overwear of work and
worry ? No people in the world work harder than do
the American people. This excess of toil might be
endured with safety were it not for the added grind
upon the vital forces of a worrying spirit. We toil
all day for the accomplisnment of a certain purpose,
and worry all night, with fear and trembling, lest
the results of our toil may not be the ripest and the
rarest of all possible fruits. The young worry about
their studies in school ; they worry about their ap-
pearance and their prospects w^hen associating with
others; they worry lest they shall fail to get rich;
they w^orry lest they shall lose some strongly invit-
ing prize in life. A great many w^omen are timid and
anxious and fearful, and look into the future con-
stantly with strained and tearful eyes. They see
lions in every path, and they worry lest they shall
fall into their clutches, and come to harm. Nine-
tenths of all the worry in this life is not only useless,
but injurious ; and nothing more certainly leads to a

98 MENTAL DISEASES

continued mental depression than worrying about
the future of this or the next life.

Worry about one's prospects, and means, and ac-
quirements is like sand poured into the bearings of a
rapidly revolving wheel. The friction and the wear
are intense; the bearings become overheated, and
necessity compels oftentimes a dead halt, a cleaning
out of the bearings, the introduction of the oil of
rest until the heat subsides ; and only after long and
vexatious delays may any renewed attempts at
progress be made. And sometimes worry so ef-
fectually destroys the bearings in the human vehicle
as to preclude the possibility of repair, and the pos-
sibility of future progress. (If you w^ould become
philosophical and happy, read Menticulture by
Horace Fletcher).

Shock. — When a person suddenly hears unfavor-
able news, such as the sudden death of a husband,
or a father, or a brother, who is absent, or when a
mother loses her child after a brief illness, or w^hen
the breadwinner of the family loses his fortune
through speculation, or his position through wrong-
doing, or his health through recklessness of living,
then comes a sudden and forcible impression which
diffuses itself throughout and prostrate the entire
nervous system. This impression, which causes the
heart to momentarily stand still, and which nearly
paralyzes the brain, is termed ** shock." The condi-
tion of the nervous system resulting from shock is re-
covered from only with great difficulty. The physical
functions are so much impaired that they work only
by a terrific strain of the system. The condition is like
that of delicate machinery w^hich has been ham-
mered, and bent, and deprived of necessary oil to re-
lieve the friction. Under the influence of shock upon

AND THEIR TREATMENT. 99

the physical system, the mental state becomes one of
depression and despair.

Brooding. — We have spoken of brooding as
another cause of melancholia. Brooding differs from
anxiety and worry in this : The person who broods
over disappointment in life or ambition quietly seeks
to keep his trouble to himself, while the victim of
anxiety and worry is quite apt to give expression to
his feelings, and thus relieve the strain upon him to a
considerable extent. Quiet brooding over the past
constitutes a most dangerous tendency to melan-
cholia.

Disorders of Faith, — These are numerous and dis-
tressing. They tend to the formation of strange and
wonderful delusions relative to the individual rela-
tionship between himself and his fellows, between
himself and the great Creator above us, and between
himself in his mortal sphere, and his relations to the
undiscovered future. Predisposition, physical causes,
overwork, worry, shock and brooding, are causes
associated with daily life and present experiences.
The disorders of faith are associated with those in-
tangible subjects concerning present and fixture exist-
ence, concerning the mortal and immortal, concern-
ing Creator, creation, and created. It would be well
if those who suffer from disorders of faith could culti-
vate a better philosophy, and restrain their unfet-
tered imaginings, and like little boys before they learn
to swim, they should only paddle near the shores of
time.

Forms

MelanchoUa may be divided as follows :

1. Simple melancholia.

2. Acute melancholia.

3. Subacute melancholia.

100 MENIAL DISEASES

4. Chronic melancholia.

5. Melancholia with stupor.

6. Melancholia with agitation.

7. Melancholia with resistance.

8. Acute delirious melancholia.

9. Hypochondriacal melancholia.

Symptoms, Courses, and Cases

Simple Melancholia. — This form of insanity is
characterized by a continued depression without the
formation of concrete delusions. An attack of the
"blues'' is the mildest type of simple melancholia.
Beyond this, you will find those who are suflfering
with continued strain of losses, and without ex-
periencing any especial shock or sudden attack, they
pass gradually into a fixed state of simple melan-
cholia. This state sometimes leads to a more severe
form, but until new developments arise the victim of
simple melancholia thinks that he is only ** bilious.*'

A strange feature of simple melancholia is that
the patient oftentimes can give no reason for the
change that has **come o'er him like a summer's
cloud." In the language of Shakespeare, he may say
to himself: **I have of late (but wherefore I know
not) lost all my mirth, foregone all custom of exer-
cises; and, indeed, it goes so heavily with my dis-
position, that this goodly frame, the earth, seems to
me a sterile promontory ; this most excellent canopy,
the air, look you, this brave o'erhanging firmament,
this majestic roof fretted with golden fire, why it
appears no other thing to me than a foul and pesti-
lent congregation of vapors."

Acute Melancholia, — Acute melancholia is gen-
erally the result of sotne sudden mental shock pro-
duced either by loss of friends, reverse of fortune.

AND THEIR TREATMENT, 101

desertion or seduction, physical disease or pain, or
by any of the great overwhelming casualities, or
calamities, or convictions of life. At first a sudden
shock of grief or despair from remorse may merely
darken or cloud the life of its victim. Then come
misconceptions of the mission and ends of life.
Customary occupations and pleasures are forsaken ;
the natural secretions and excretions of the body are
hindered and impeded. As the courage fails, so like-
wise the strength. The patient loses his appetite,
and as nourishment is taken in insufficient quantities,
and but poorly assimilated, the patient wastes in
flesh, and becomes wrinkled and prematurely aged
in appearance.

The person suffering from acute melancholia gen-
erally looks down; keeps quiet; scowls; refrains
from talking ; dislikes to be spoken to ; is averse to
the consolations of friends; and in many ways he
presents outwardly those appearances of degenera-
tion which are characteristic of inward hopelessness.

At first the victim of acute melancholia may seem
to have no definite delusion, but after a short time
the vast and formless feelings of profound misery
take shape as a concrete idea. In other words, his
sorrow is condensed and crystallized into some defi-
nite delusion. The patient comes to believe that he
has committed a great crime, for which he must
suffer death; that he has blasted the happiness of his
family ; that he is possessed of the devil, or that he is
the victim of a persistent and cruel persecution by
electricity, or by magnetism. And again, he has
committed the unpardonable sin, and is forever
damned. The delusion is not the cause of the feeling
of misery, but is engendered by it. These unhallowed
fancies take shapes according to the patient's culture

102 MENTAL DISEASES

and education. What the uneducated and supersti-
tious attribute to witches or to devils the man of
culture ascribes to electricity, or magnetism, or
political conspiracy. In certain cases it is striking
how disproportionate the delusion is to the extreme
mental anguish ; how^ inadequate it is as the expres-
sion of it. One whose agony is that of the damned
will swear that it is because he has drunk a glass of
beer w^hich he should not have done, or because he
has muttered a curse when he ought to have oflFered
a prayer. With him who believes that he is doomed
to infinite and eternal misery, it is not the delusion
but the affective disorder that is the fundamental
fact. There can be no adequate or definite idea of
the infinite or eternal, and the insane delusion of
eternal damnation is but the vague and fiitile at-
tempt at expressing an unutterable real suffering.

It is noteworthy, again, how much the affliction
of the melancholiac subsides when a definite delusion
is established. The vast feeling of vague misery
which possessed the w^hole mind has undergone sys-
tematization in definite morbid actions. When the
delusion is not active, but reposes in the background,
the patient may be tolerably cheerful.

A suicidal feeling is common in cases of acute
melancholia. Hence a patient suffering with this
form of insanity should always be watched and
cared for, lest in some paroxysm of agony he should
seek both to kill some of his friends and himself.

Acute melancholia may terminate in recovery, or
it may culminate in an attack of mania. If death
ensues, it usually results from exhaustion.

No. 5,414, set. 28, unmarried, was a case of acute
melancholia in a woman, resulting from overwork,
and a love affair of an improper nature. The patient

AND THEIR TREATMENT, 103

was a dressmaker, hence her life was necessarily
sedentary, and the opportunity for exercise in the
open air was limited. Such conditions are apt to
produce tendencies to mental depression. The dura-
tion of the attack previous to admission to the
hospital was about six months. When she came
under our care the patient's general health was
much impaired, and she had lost considerably in
weight. The mental condition was that of profound
depression, coupled with anxiety. She was also
suicidal, and had threatened to kill others. It is not
uncommon for a case of suicidal melancholia to
make an assault upon others just previous to self-
killing. People who try to kill others, and then try
to kill themselves, labor perhaps under the old-time
theory that ** misery likes company. *'

The patient in question w^as sleepless, emaciated,
and showed numerous scars and abrasions from self-
mutilation. She w^as also constipated, and had a
poor appetite. The will power was very weak, and
she needed constant reassurances from nurses and
doctors to the eflfect that her **soul was not lost.'*
The expression in her face was that of hopelessness,
which is so characteristic of acute melancholia, and
yet the patient was tractable, and willing to obey
the directions of the attending physicians. In a short
time, under suitable care, she was taking liquid food
in abundance, and sleeping better than at first. She
also became more cheerful in spirits. About six;
weeks after admission to the hospital, she was
troubled with sexual excitement at times, and had
difficulty in keeping her mind off improper subjects.
She had amorous dreams. This revival of activity
in the sexual organs is sometimes an indication of
improvement in cases of melancholia. In due time

104 MENTAL DISEASES

the menstrual function was renewed, and there was
an improvement in spirits, and an increase in flesh.
Having commenced to improve, the gain in bodily
weight and in lightness of spirits was steady, until
she made a full recovery. She went home in less than
six months from the date of her admission. Her
weight was 127 pounds, showing a gain of 22
pounds during her stay in the hospital.

The remedies which this patient received while
tinder treatment were Ignatia, Picric Acid, Pulsatilla,
Cantharis, and Cimicifuga.

Here was a case of acute melancholia in a young
person, caused by what seemed to her an over-
whelming misfortune, and which brought on all
those mental and bodily symptoms which make the
diagnosis clear and positive. When placed under
treatment, and compelled to live in a careful and
methodical way, she became more philosophical and
serene in mind. The gain in bodily weight w^as
synchronous with the resumption of normal and
elastic spirits. Every such case is an exemplification
of the old adage, to the effect that a sound mind is
to be found only in a sound body. The rebuilding of
the physical health in a worn, emaciated and de-
pressed individual, is the first step toward a satis-
factory recovery.

Subacute Melancholia, — ^Under the head of sub-
acute melancholia we class those cases which, from
a natural predisposition, incline to a survey of life
from the dark side. It is often difficult to determine
in this class where sanity leaves off* and insanity be-
gins. The patients do not present the marked ob-
jective symptoms of mental agitation and physical
decay which present themselves in acute melan-
cholia, nor do they develop the fixed delusions so

AND THEIR TREATMENT. 106

generally held by those suffering with the chronic
form.

Subacute melancholiacs are mercurial in their
nature, now rising to heights of sunny pleasure, and
again slowly sinking to the depths of despondency.
Such cases may . recover, or they may drift into a
chronic state. If they do recover, they are quite
likely to suffer relapses. Their only hope is to join
their fortunes with those who are strong, vigorous,
and exuberant in spirits. They should live in the
mountains, and in the open air.

Chronic Melancholia, — Chronic melancholia is the
terminus of all other forms of spirit depression. It
is the inevitable goal of continued mental shock, and
worry, and brooding, and physical decay. The term
is an epitome of all the disappointments of fickle
fortune. The condition is a sarcasm upon human
happiness, and the ultimate of vengeful fate. The
means to this end are false and unsatisfying philo-
sophies. Its field of operation is wide as the world,
and the number of victims which this Giant Despair
claims for his own is as myriad and legion.

Chronic melancholia is a grim and ghastly entity ;
a fetid reminder of better and brighter days ; a sad
relic of unprofitable and useless existence ; a symbol
of blasted hopes, broken plans, and a ruined life.

Patients suffering with chronic melancholia may

live for years, mourning constantly over their fate,

repeating daily their threadbare delusions; always

looking into the darkness, and never seeing a ray of

sunlight, until at last, worn and wasted by useless

worriments and forebodings, their lives are finally

exhausted, and their spirits shattered by continued

beatings against the bars of a relentless fate.

Phthisis, marasmus, dropsy or death from ex-
8

106 MENTAL DISEASES

haustion are the sequelae of chronic melancholia^
although occasionally a case recovers.

Just here we desire to present a brief history of a
remarkable case. The case is remarkable in these
particulars : First, from overwork and over-anxiety
the patient passed into a condition of acute melan«
cholia ; secondly, from acute melancholia she passed
into a condition of subacute mania, with marked
delusions and semi-exaltation ; thirdly, she subsided
into the passive, non-elastic state which may be
described as subacute melancholia; fourthly, she
passed into chronic melancholia ; and, fifthly, after a
lapse of ten years, she fully and substantially re-
covered.

Miss W., aet. 29, while overtaxed from constant
daily labor as a teacher, was subjected to excessive
mental excitement, agitation and anxiety from
sympathy for a sister who was in great danger dur-
ing instrumental labor. She was also much over-
worn by the subsequent illness and death of the
sister's child, the care of which fell heavily upon her.
As a result of these severe toils, she was attacked
with headache, vertigo, ringing in the ears, and
slight delirium. She had a rapid pulse, a flushed
face, and wild, wandering eyes at times. Her tongue
was coated white, and she had thirst, constipation,
scanty urine, restlessness, agitation, and sleepless-
ness. In about three weeks after the inception of
her attack there was an apparent gradual amend-
ment. The fever subsided, the tongue cleaned, the
appetite and the general health improved, but there
yet remained a disordered mind, more or less gastric
disturbance, and some emaciation. She still re-
mained restless and sleepless, and indulged in false
beliefs and false judgments. The patient was.

AND THEIR TREATMENT, 107

strongly conceited, and had fall faith in the correct-
ness of her o^wn judgments ; fancied that her friends
were all insane ; that people were constantly watch-
ing her; was in dread of being buried alive; often
fancied herself a dog, and indulged in numerous
other false impressions. With these false beliefs and
judgments she had such recklessness, and such disre-
gard for the rules and usages of the family, that she
not only interfered with the ordinary comfort of her
friends, but excited grave apprehensions in the minds
of those around her, lest she should do them or her-
self some bodily harm. This patient was naturally
affable, amiable, of nervo-bilious-sanguine tempera-
ment, and of cultivated and refined tastes. At times
she was quiet, and again very restless, and still alto-
gether moody and irritable.

The patient, after admission to the hospital, at
first complained of pain in the back and side of the
head, ringing in the head, constriction and stiffness
about the head and face, a parched feeling of the
mouth ; tongue felt as if burned on the sides and tip,
bowels constipated, sensation of falness after eating,
a numbness of the body, depressed spirits. She said :
"I don*t see any use in living if I can't do any one
any good." She was worse in the house, and about
sunrise; later in the day and out-of-doors, she felt
somewhat better. The patient was always self-con-
ceited, and at times quite emphatic in the expression
of her disdain for others. She was given Platinum,
and this remedy was continued for some time. Four
months later her menses appeared for the first time,
and after that she seemed a little better for a while.
She thought she was "coming out of a cloud," and
that she would feel better again. Then she thought
that the steeple, which was being put upon one of

108 MENTAL DISEASES

the new buildings at the institution, was a gallows
on which to hang her. Soon afterwards she realized
that she had worked too hard, and that this was the
cause of her suiBFering. The following year she
settled into a dull, heavy, gloomy state. Her active
delusions had in a measure subsided ; and at times
she brightened a little, and then would settle to the
old plane of living and thinking. Two years later
she began to be a trifle more sensitive. Passing
from a subacute to a chronic stage she became more
irritable and suspicious, and was inclined to write a
good deal. Her letters were fretful and faultfinding
reiterations of her troubles and her woes. Again,
she passed into a state of slight exaltation. She
played upon the piano for the patients at regular
chapel services for a time, and then sent in a bill for
one hundred thousand dollars, reckoning at twenty-
five thousand dollars per year, and charging for four
years, when she had been in the hospital but three
years. Later the patient complained of frequent
pains in her head, and had several attacks of nose-
bleed. She felt as if her head were coming off; had
frequent dreams ; had a cough, with greenish expec-
toration, and much rattling in the throat and chest.
For these latter symptoms she received at one time
Mercurius lod., and at another time Antimonium
Tart. The next year she had frequent attacks of
diarrhoea, which came on in the night and towards
morning, and these were relieved by Podophyllum.
She was troubled with hoarseness, but no cough.
She also had smooth, dark-red, non-vascular erysip-
elas on the extremities. She had bleeding hemor-
rhoids, with constipation, and severe lancinating
pains running up the rectum. The remedies for that

AND THEIR TREATMENT, 109

year were Podophyllum, Phosphorus, and Corrosive
Mercury.

In the early part of the following year the patient
ran down to seventy-nine and a half pounds in
weight ; complained of neuralgic pains in the head,
face and jaws. During the latter part of the same
year she began to gain in flesh, and continued to
gain until she weighed eight-five and a half pounds.
She complained that people were laughing at her;
was tyrannical in disposition, and troublesome on
the ward among other patients; complained of
pains in neck, shoulders and arms, with numbness
in the latter at times. She also complained of sharp,
cutting pains while urinating. This condition was
relieved by Cantharis. She continued to gain in
weight, but the following year she became dull and
sleepy at times, and had dull pains over the eyes in
the forehead; was somewhat feverish, and com-
plained of her heart feeling as if it would stop. The
patient had a severe attack of tonsillitis, and there
was considerable swelling in the throat. Gelsemium,
Belladonna, and Iodide of Mercury were her reme-
dies for this year. Early in the next year she began
to improve mentally; was able to write sensible
letters, and did not appear to have any delusions.
She was very anxious to go home; menstruated regu-
larly, slept well, and had a fair appetite. Her weight
at this time was one hundred and two pounds. She
then had a brief depressed period, and indulged in a
crying spell, for fear she would go crazy again. The
depression was very brief. In a short time she was
better and more cheerful. Lilium Tigrinum was the
remedy administered to quiet her fears about going
crazy. Five months later she was paroled for a
month to visit her friends, and at the end of that

110 MENTAL DISEASES

time returned to the hospital voluntarily. She then
talked sensibly and rationally in every particular,
and her speech, conduct and self-control were con-
sistent with perfect mental health. She was then
discharged from the hospital as fiiUy recovered, just
ten years from the date of her admission. She has
remained well since leaving the institution, and is
now earning her living, as she did before coming to
the hospital, by teaching music.

Melancholia vsritb Stupor, or ^^Melancholia At-
tonita.^^ — This is a somewhat rare disease, but in-
tensely interesting from the fact that it is con-
founded with primary dementia, or at least it
simulates a state of utter mental failure. Besides
mental depression and mental obfuscation, there
often exists in the patient thus afflicted a condition
simulating typhoid fever. Here we have melan-
cholia, dementia, and fever in a single case. At first
the claw-hiding paw of unaccustomed sadness is laid
gently upon the doomed suflFerer, and it is only when
the capture is assured that the stunning blow of
dementia falls upon the stricken one, and the sullen
fever begins its deadly course. In such cases we find,
first, self-depreciation, coupled with the motionless
fear of melancholia ; and again, there is embarrass-
ment of thought, an intellectual inertia, a slowness
and incompleteness of ideational conception that be-
longs only to dementia. (M. Baillarger). Thus we
have a combination of both melancholia and demen-
tia, a unification so perfect and harmonious as to
apparently preclude separation. Now in such a dis-
ease there is likely to arise difficulty in the line of
making a diagnosis. In short, we must differentiate
between the new combination (chemically con-
sidered) and its formative elements.

AND THEIR TREATMENT, 111

Melancholia with stupor may be differentiated
from primary dementia, ** first, by the expression of
the countenance, which in melancholia is contracted,
and marked by an intense although an immovable
expression ; while in dementia, it is relaxed and ex-
pressionless. Secondly, in abstracted melancholy
the patient resists being moved, sleeps badly, and
often refuses food. In dementia, he complies with
the wishes of the attendant, has a good appetite,
and sleeps well. Thirdly, in abstracted melancholy
the bodily functions are more seriously affected than
in dementia. The body is emaciated, the complexion
is sallow, the skin is dry and harsh, and the secre-
tions generally deranged; whereas in dementia the
body often retains its plumpness and the secretions
are little altered from a healthy standard. Fourthly,
after recovery, the patient who has been affected
with abstracted melancholy is found to have re-
tained his consciousness through the whole period of
his disease. When recovery takes place from pri-
mary dementia, the past is found to have left no
traces in the memory.*' (Bucknill & Tuke). Thus
we distinguish this multiple disease from one of its
combining forms, i. e., dementia.

From melancholia we distinguish it by the pri-
mary intensity of mental anguish, — too deep for
utterance — and by the subsequent apathy, apparent
loss of the powers of thought, and utter disinclina-
tion to all mental and physical action. In the ordi-
nary forms of melancholia the patient is generally
able to express himself clearly and cogently, al-
though he may labor under the delusive idea that
his soul is lost, or that in the body he is about to
suffer the pangs of starvation.

Now in addition to the mental status already

112 MENTAL DISEASES

described as existing in melancholia with stupor, we
find in some cases a pathological condition of the
physical system simulating t3rphoid, which both
complicates the disease and increases its already
dangerous tendencies. We think that this fever is
usually the result of personal neglect, the natural
outgrowth of the profoundly beclouded mental state
into which the patient has sunk. As a rule, the
bowels become loaded with a large amount of undis-
charged fecal matter ; and this, like any other irrita-
tive foreign substance, induces a slow inflammation
of the intestinal tract, with a consequent rise of tem-
perature, and an increased frequency of the pulse.
Accompanying the fever we have an intensely dry and
hot skin; a thick, moist and heavily coated, or dry
and coated tongue ; loss of appetite, with obstinate
refusal of food, and a somewhat hurried respiration.
While some of the symptoms, mental and physical,
simulate typhoid, w^e do not have the exhaustive
diarrhoea of the latter, nor such a rapid failure of
the life forces as may occur in zymotic disease.

During the febrile state of melancholia with
stupor, which sometimes continues for several
weeks, the patient is, at times, restless and sleepless^
tossing the limbs about, and lying with open eyes,
yet in a dazed condition; or he appears to be dull
and comatose, and is aroused with the greatest diffi-
culty. As a rule, the patient pays no heed to the
ordinary demands of nature. The urine is either
retained, requiring persistent removal with a cathe-
ter, or it is frequently discharged in the bed, thus
keeping the patient constantly in a wet and un-
cleanly condition. The bowels are also remarkably
inactive, and will remain dormant for weeks unless

AND THEIR TREATMENT, 113

their contents are brought away by the use of
enemas.

In this strange disease all the machinery of life is
thrown out of gear ; the smoothness of its workings
is impaired, and the yIs vitalis is changed to a
biolytic force, dangerous as dynamite, and whose
only impulse is to tear down the citadel in which it
is lodged. And yet it is a disease which may be suc-
cessfully treated and cured. The patient must be
artificially fed with a soft rubber catheter through
the nose. The bowels must be emptied by suitable
means, and the bladder must be cleared of its con-
tents at regular intervals, that is, two or three times
in twenty-four hours. Such remedies as Baptisia,
Ignatia, and Bryonia may be administered with the
liquid diet through the nasal tube.

Melancholia with stupor is, as we have stated^
usually ushered in with simple depression of spirits.
This may occur without previous mental derange-
ment, or it may ensue in the course of an attack of
mania. We have had patients brought to the hos-
pital whose disorders were rapidly and fiiUy devel-
oped at home under the pressure of some social or
financial disaster, and, again, we have had others
who passed into this state after sufifering with other
forms of insanity for many months. In either case
we have found melancholia to be the first symptom.
This, however, is speedily followed by dementia,
that pitfall which lies at the end of insanity's high-
way, and which has been fitly termed **the grave of
the human mind.''

Melancholia with stupor may terminate by speedy
recovery, by absolute dementia, or by death. If the
patient gets well at all, recovery ordinarily occurs
within a few weeks, or, at the most, within from two

114 MENTAL DISEASES

to six months from the date of inception. The re-
covery is often as sudden and unexpected as was the
onset of the disease. The temperature subsides ; the
pulse becomes softer and less rapid; the sick one
sleeps, and awakens to find the stone of sadness
rolled from the heart, while the soul's recesses, once
darkened by despair, are again radiant with newly
received light.

Profound mental shock may be classed as the
prime cause of melancholia with stupor. Such
shocks are most commonly experienced by women
who are young, of delicate fibre, highly sensitive,
and extremely emotional in their natures. In such
persons the play of passion is often of a tragic char-
acter, and the blighting of affection, the loss of a
child, or the sudden wreck of a fortune is sometimes
followed by a benumbing shock, in whose trail
march the sad sequences we have already enumer-
ated.

Where melancholic stupidity occurs in the course
of insanity already established, it is difficult to state
the positive cause, yet even here we believe it to be
due to some suddenly depressing or exciting emo-
tion. How far one's natural sensitiveness is re-
tained, in the ordinary courses of insanity, it is
difficult to state. Sometimes, however, it is greatly
increased. With this hypersensitiveness, which we
often find, it is not at all wonderful that having
found no relief in the oft-repeated, long-continued
wail of words, the patient should finally cease to
speak, "strangle his language in his tears," give
himself up to utter abstraction, and thus find at
least temporary respite from his real or imaginary
troubles. And if the woes of life are not thus
crushed, the victim may yet hurry on to the Lethe of

AND THEIR TREATMENT, 115

that dull forgetfulness which leaves both hope and
care behind. The cause of this partial mental pa-
ralysis lies in the fact that every emotion of joy and
hope has been chilled by the rude touch of heart-
breaking disappointment. The mad world is filled
with the dark clouds of despair, and the most ex-
alted maniac is at times ** wrapped in dismal think-
ings," and given over to ** thick-eyed musing and
cursed melancholy.'' Between this primary depres-
sion and the succeeding stupor which simulates
dementia, there is but a single step. The fever comes
later, but is inevitable unless the patient's bodily
fanctions are watched and attended to by his
friends.

Melancholia with Agitation. — Over against mel-
ancholia with stupor we have melancholia w^ith
agitation, where the person walks, or stands, and
wrings his hands, and pulls out the hair, and chew^s
off the finger nails, and picks holes in the skin, and
moans and groans, and deplores the fate of life.
Patients suffering with agitated melancholia are
often greatly distressed over religious matters, and
such cases are sometimes termed "religious melan-
cholia."

Melancholia with Resistance, — This is another
distressing form of melancholia. Patients suffering
with this disease resist every attention and care.
They resist being washed ; they resist having their
hair combed ; they resist all attempts at dressing or
undressing; they turn away from their friends, and
either curl themselves up, hiding their faces in their
pillows, or they lie straight on their backs, and turn
away from every one who approaches them. Cases
of resistive melancholia will often emaciate very
rapidly, because they refuse to accept proper nour-

116 MENTAL DISEASES

ishment. They also become very filthy, because
they resist the calls of nature, and are opposed to
every attempt on the part of the nurses to relieve
the overloaded bowels and bladder.

Acute Delirious Melancholia, — This very rare
form of melancholia has been reported by Charles
Henry May hew in Vol. I., West Riding Reports. It
is one of the most formidable diseases which the
physician is liable to be called upon to treat. There
exist, in the main, the physical conditions of
typhoid, or of acute mania, but instead of that
mental indifiference usually found in severe fever, or
the reckless exuberance of spirits often noticed in
mania, there are anxiety, unrest, hopelessness and
despair. When hope has flown, and corroding care
supercedes that apathy which is really a conserve^
tive force in fever, then, indeed, is the heart sick, and
life in the last degree jeopardized. It is, therefore, a
most potent fact that ^*the vital energies are more
imperiled in cases of delirium where there is men-
tal depression than in those cases where there is
mental exaltation.'' The disease, perhaps, depends
upon a state of septicaemia, or upon some morbid
poison in the blood, or a disturbance in its constitu-
tion. As far as I am aware, the blood has never
been chemically examined in such cases, so that we
have no information as to whether changes exist in
its physical properties or composition. The symp-
toms, however, point to some toxic condition in the
great nourishing and co-ordinating fluid, producing
destructive effects throughout the system. The
febrile condition, the general weakness and uneasi-
ness which mark the outset of the disease; its sudden
incursion and quick impUcation of all the secretions
and excretions; the rapid and extreme expenditure

AND THEIR TREATMENT, 117

of flesh and strength, and the tendency observied in
some cases to multiple centers of inflammation or
suppuration, are all compatible with a poisoned
state of the blood, or the presence in it of effete or
deleterious matter. That one should suffer the deli-
rium of despair, under such conditions, is not sur-
prising.

Some one has said that prognosis is materially
affected in diseases generally by a careful considera-
tion of the emotional state. On the one hand, we
find those who are delirious and depressed ; and on
the other, hilarious and jolly. When a patient
laughs and frolics, however noisy in language or
outrageous in conduct, the prognosis may be favor-
able. It is said that gaiety indicates a reserve force
which does not exist in cases of depression. Thus
we see that different types of mental disorder corre-
spond with different abnormal states, and thus sig-
nalize with nice precision the progress of patholog-
ical changes in the brain. It is always well to make
an analysis of delirious ideas, and to differentiate
those which tend to anguish, dejection and gloom,
from those which are buoyed up with hope, exuber-
ance and joy. Unless you can speedily and abun-
dantly nourish the emaciated victim of acute deli-
rious melancholia, and unless you can change and
stimulate the current of his thoughts, you will be
likely to lose the case.

Now for a case or two. Miss E. J. N., aet. 30.
The certificate of commitment states: **She sits in
her chair with her mouth wide open, her face fixed
on vacancy, while the muscles of her face twitch spas-
modically. Sometimes she tightly closes her teeth
and lips, refusing to take food or drink, imagining
that it is poisoned. She refuses to speak ; sometimes

118 MENTAL DISEASES

screams wildly, and is violent." We noticed that
her hands were tightly clenched, and she resisted
every attempt at moving her arms. At times she
seemed to be intensely frightened at some imaginary
object. On the day following her admission the
patient was restless and uneasy; her hands were
moist and constantly clenched; the skin was hot,
pulse high, temperature about 100. On account of
her obstinacy, her refusal to eat, and constant
twitching of the extremities, we gave the patient
Zincum. For several days she slept but little ; was
very weak ; failed to pass water, or to have a move-
ment from the bowels ; did not respond to remedies ;
and was barely kept alive by the administration of
beef tea and milk through a soft rubber nasal tube.
Twelve days later the thermometer in the patient's
axilla registered 106^^, the pulse about 146, and
respiration 52 per minute. All indications were
those of a speedy collapse. At this juncture we pre-
scribed Baptisia, five drops of the mother tincture in
half a glass of water, a teaspoonful every half hour.
In the afternoon an enema was given for the relief of
the constipation, and a considerable amount of feces
was discharged. At 9:15 in the evening the tempera-
ture was 105^^, pulse 140, respiration 46, showing a
slight change for the better. On the following morn-
ing the temperature was 104^2^, pulse 120, respira-
tion much less rapid, skin not so intensely hot as on
the day previous. The patient's bowels were still
much bloated and tympanitic. The temperature
gradually decreased from 104 to 100^% in four days.
As improvement so happily succeeded its use,
Baptisia was continued at lengthening intervals.
Then the patient began to talk. In reply to a ques-
tion, she said : ** I feel better, but I don't know what

AND THEIR TREATMENT, 119

I am." During the remainder of the month the
patient continued to gain steadily. This improve-
ment continued during the next two months, until
complete recovery was the result of her treatment.

The foregoing is a severe and typical case of
melancholia with stupor. One of the best features
of this class of cases is the fact that under careful
treatment and good care a large proportion of them
recover.

We now present a typical case of acute delirious,
melancholia, and, as you will observe, the results
were quite the opposite from those contained in the
treatment of a case of melancholia with stupor.

Mr. H. W. W., set. 54, married, good habits.
The causes of his insanity were given as heredi-
tary tendency, business troubles, and worry. His
father was insane and committed suicide. The dura-
tion of insanity previously to admission w^as one
w^eek. While at breakfast one week before admis-
sion, Mr. W. suddenly threw up his hands and said :
"I am lost, lost." He was persuaded not to go to
work that day. The next day he stabbed himself
about one and a half inches over the left nipple, and
on the following morning jumped into the river, but
was rescued. For several weeks previous to this,
attack he had been unable to sleep, and was
troubled with dreams when he did sleep. When
awake he seemed to have a horror of something. He
thought that because his father was insane he would
be, and this led to a belief that he would commit a
terrible crime, for which his soul would be lost. The
day after admission he wished to go home, as he
thought that he had no means with which to pay his.
board. He had no hope, whatever, for himself, and
was anxious to die. He became excited, noisy, irra-

120 MENTAL DISEASES

tional, and tried to injure himself by striking his head
against the wall. He accused himself of forgery, of
ruining people, and of misrepresenting. His pulse
was 120 ; the skin was hot ; he was intensely rest-
less, and thought he was about to die. He was
given Aconite in water. While taking the medicine
from a tumbler, he bit out a piece and chewed some
of the glass, but this he was persuaded to spit out.
He continued sleepless and suicidal, yet he had a
good appetite for several days. At times he would
not speak, and on one occasion he stared into
vacancy without winking for about four minutes by
the watch. He afterwards became terribly excited ;
tried to bite himself; was restless, desperate, and
determined in self-destruction. His tongue was dry,
pupils moderately dilated, and his appetite began to
fail. The patient tried so constantly to injure him-
self by kicking about, that he bruised his ankles and
knees, and disfigured his arms. At times he would
yell for considerable periods at the top of his voice.
At length he began to perspire very freely, and his
strength failed. When his hands were free he tried
to tear out his eyes, consequently his hands were
placed in padded mittens. By reason of his long-
tiontinued mental and physical excitement, he gradu-
ally became exhausted and drowsy. He said he was
all tired out, and yet he slept but moderately. He
began to experience difficulty in retaining food. His
tongue was dry and coated; his face pale and ca-
daverous. He said that he had no pain, but was '* so
tired." This exhaustion continued until he died,
just three weeks from the date of admission.

The temperature in this case was moderate, rang-
ing from 98 to 101. The pulse was likewise moder-
ate most of the time, ranging from 72 to 108, and

AND THEIR TREATMENT, 121

only twice rising to 120. The mental agony and the
physical excitement were absolutely intense, and
wore out in a short space of time a naturally strong
and healthy man. The vigor and intensity of his
mental and physical action might be likened to that
of a dog suffering with hydrophobia. Such cases
are almost hopeless, and, with few exceptions, they
rush themselves into the grave in a very few days.
There is little or no use in taking such patients to a
hospital. The jar caused by riding in a car or car-
riage greatly aggravates their condition. They
should be kept at home, closely watched, restrained
in bed, carefally nourished, bathed frequently in hot
alcohol and water, and the issue patiently awaited.
Hypochondriacal Melancholia, — Last in the list
of definite melancholias, we may name hypochondri-
acal melancholia, or hypochondriasis. This is a
form of mental disorder where all the thoughts and
beliefs of the victim are centered upon himself. He
has the worst liver, the biggest gall, the smallest
heart, and the most inadequate lungs of any one in
existence. Such cases are forever reiterating the
belief that they have an incurable disease ; that they
are afflicted with cancer ; that their bowels do not
move ; that the stomach is being filled with innumer-
able gallons of milk ; that some animal is gnawing
at their intestines; that the heart is failing to per-
form its fimctions ; and some of them go so far as to
think that they are ** going crazy." Now it is prob-
able that in many cases the hypochondriac is
afflicted with some fiinctional nerve disorder, which
causes pain and uneasiness, and which gives rise to
the exaggerated belief that, there has been some
wonderfal organic change in the bodily tissues.
Hypochondriacs should be carefully examined, and
9

122 MENTAL DISEASES

they should be favored and humored as much as
possible.

The story is told of a woman \srho thought she
had a frog in her stomach. Her physician finally
concluded to cure her of this belief, and one day gave
the patient an emetic, and while she was throwing
up the contents of her stomach he quietly placed a
live frog in the bowl w^hich contained the ejecta.
Upon seeing the frog, the woman was relieved of her
delusion, but in a short time she said: "Doctor,
there must be some young frogs in my stomach.''
The doctor picked up the frog which he had placed in
the bowl, and looked at it, and said : ** Madam, that
is impossible, because this frog is a male.'* Then she
gave up her delusion entirely.

So long as the delusion relates simply to a sup-
posedly diseased condition of the body, there is a fair
chance for recovery. But if the patient comes to
believe that there is a ball of fire in the bowels, or
that an animal is gnawing at the intestines, or that a
nest of little devils is being hatched out in the womb,
or that the heart and lungs are being cut out and dis-
sected for the amusement of the doctors, the chances
for recovery are very limited. If a person cherishes
the delusion that he is poverty stricken, and that he
and his family are coming to want, we regard the
case as a hopeful one, particularly if the physical
energies are only moderately exhausted from refusal
to take food. Those who think they have committed
a great crime, or the unpardonable sin, do not
readily yield up their delusions.

Melancholia, at the outset, does not seem to in-
volve the intellectual faculties. The victim may talk
coherently and reason cogently upon all topics ex-
cept with regard to his dark and deplorable beliefs.

AND THEIR TREATMENT, 123

When patients recover from melancholia they are
often much happier than they have ever been before.
They seem to rise to the loftiest heights of exuber-
ance and enjoy each day of existence, in happy con-
trast to those desolate periods when they were suf-
fering most acutely with neuralgia of the soul.

Prevalence and Prevention

Melancholia is probably the most prevalent form
of insanity known to history. Especially since the
invasion of the grip, we have been burdened with
numerous cases of mental depression. Almost every
form of insanity is at times tinged with elements of
mental depression. General paresis is frequently
ushered in with an attack of melancholia. The same
may be said of mania; while hopeless and helpless
dements sometimes brighten a little, and then, feeling
their own weakness, sink into the abyss of despond-
ency on their way back to utter fatuity.

The prevention of disease is a grander and more
beneficent achievement than the cure of the gravest
malady. The surest prophylactic against melan-
cholia is the leading of a regular, natural and health-
fiil life, and the moderate and reasonable use of all
good things with which the earth is so bountifiiUy
supplied, and which may be had by those who exer-
cise a proper industry in attaining them. Excess of
youthful pleasures is always followed by the retribu-
tion of subsequent despondency. But youthful
pleasures were designed for wise and noble purposes,
and should not be utterly avoided. A man who re-
fuses all good things and becomes an ascetic is in just
as much danger of drifting into ** innocuous desue-
tude '' as the glutton is liable to tumble into the pit-

124 MENTAL DISEASES

fall of reckless extravagance. Those who pursue the
even tenor of their way, and live according to the
Latin suggestion, in medias res, may never scale the
loftiest peak which ambition may point out, and
neither shall they feel the pangs of utter disappoints
ment when they fail to reach the topmost crag.

To prevent melancholia you should live patiently
and regularly, yet withal earnestly, and with a con-
stant cherishing of good motives and aims of life.
Thus you may accompUsh an excellent life-work.
Your destined mission is thus fulfilled, and you will
be able to smile at Fate, and under every vicissitude
of life you may be able to say: **I have neither the
scholar's melancholy, which is ambition; nor the
musician's, which is fantastical ; nor the courtier's,
which is proud; nor the soldier's, which is ambi-
tious; nor the lawyer's, which is politic; nor the
lady's, which is nice ; nor the lover's, which is all of
these."

The treatment of melancholia will be considered
in another lecture, in conjunction with the treat-
ment of other forms of insanity.

Pathological States

The pathological lesions in melancholia are some-
times difficult to discover— that is, in their finer
aspects. In a general way it may be stated that a
passive congestion of the cerebral sinuses is a com-
mon condition. This congestion acts as a dam, and
prevents the normal flow of nutritious blood
through the cortex of the brain. This congestion of
the venous circulation produces pressure which, if
unrelieved, leads to atrophy, or wasting of brain
tissue. In melancholia with excitement there is

AND THEIR TREATMENT, 126

probably an active hyperemia of the brain — a condi-
tion similar to that existing in acute mania. If the
melancholy patient is quiet, and indiflFerent to sur-
roundings or the inception of nourishment, the
brain may become anemic, and even edematous.
The nerve cells being unused in a normal way are
apt to waste in such a manner as to favor the
hypertrophy of connective brain tissue. Unless the
brain cells are used in an active and judicious
manner they will certainly atrophy, and the spaces
thus rendered vacant will be filled with useless
material.

In studying the pathology of melancholia, you
will often find diseased conditions of the abdominal
viscera, and to such conditions may often be attrib-
uted much of the mental distress which has invaded
the life of the individual thus afflicted. In the brain
itself we often find but slight evidences of disease
even where the patient has died in his unfortunate
and depressed state. But even slight pathological
developments in the brain will sometimes reveal the
fact that its mental occupant was overborne in a
most destructive way by forbidden and abhorrent
forces, until it finally gave up the contest against
the "slings and arrows of outrageous fortune."

The track of a vessel, as it disturbs the surface of
the ocean, is speedily washed away. The casual
observer sees upon the sunlit billows nothing to pro-
claim the fact that a steamship has ploughed
through those obliterating waves. But the keen-
eyed and long-experienced mariner discovers upon
the telltale waters oil from the machinery, and
ashes from the pit, and a bit of sable ribbon torn by
the winds from a black flag, and he knows from
these that a stranger and a pirate has passed that

126 MENTAL DISEASES

way. So the phantom bark of melancholia may
sweep along the sinuses, and glide up and down the
arterial courses, vexing the shores of the cerebral
convolutions, yet leaving but little of track or trace
by which its ravages may be noted or measured.
Yet skilled investigators, profiting by repeated
observations, are fast discovering, and marking out
with faithful hands and by unmistakable signs, the
course and the character of this unseen but deadly
enemy of mental health.

LECTURE VI

MANIA

The subject of to-day *s lecture is Mania. The term
mania, from the Greek fuuvofuu, ^*I am furious,"
means a raving or furious madness. It is used to ex-
press all forms of intellectual or emotional excite-
ment where there are exaltations of the mental
faculties, from distorted impressions and imperfect
consciousness at the outset, on to disgruntled rea-
soning powers, dilapidated judgment, disordered
will, delusions of innumerable types, and hallucina-
tions of various kinds.

Incongruity and unnaturalness of thought,
speech, and action are characteristics of mania ; and
through all the workings of a thus unbalanced mind
there run a more or less constant series of impulses
to works of fiiry and violence. Hence, the term
mania, a most fitting word to convey the idea of a
human mind given over to the demon of unrest. In
a general way, Shakespeare stated the case correctly
when he wrote: **He foams at the mouth, and by
and by breaks out to savage violence.''

The form of insanity which we shall attempt to
describe is a favorite form, so to speak, of writers in
both ancient and modem times. Shakespeare's King
Lear is one of the best classical models of acute
mania tending to senile dementia in an imperious
yet despairing old monarch. We find likewise cases
of insanity in the writings of Dickens, and Scott,
and Charles Reade, and Captain Marryatt, and in

128 MENTAL DISEASES

many other works of fiction. In fact, throughout
all literature, these abnormalities of human nature
come to the front, and display themselves as fasci-
nating fantasticals in the solemn procession of real
or fictitious life.

Causes

The causes of mania are put down in the books
under such heads as loss of property , mental anxiety,
overwork, illhealth, injury to the brain, sunstroke,
and many other expressions which denote that the
victim has experienced during his earthly sojourn
some unfortunate disaster in mind, in body, or in
estate.

The general causes of mania are much the same
as those which produce melancholia. In the latter,
however, the shock w^hich produced the disorder
works in such a way as to cause depression, while in
mania the causes of mental injury tend to the pro-
duction of irritation and of excitement. In demen-
tia, the causes of insanity tend to bodily exhaustion
and mental failure, while in general paresis the shock
of disease comes after long and unwise contact with
worry, wine, and women. Perhaps the tempera-
ment of the individual determines, to a large extent,
the form of insanity which will crop out in a given
case. In the production of artificial insanity by the
use of stimulants, you will find that some men be-
come depressed after drinking ; others become hilari-
ous, boisterous, noisy, and pugilistic; others sink
into the fatuous and besotted state of dementia;
and again, others simulate general paresis by the
development of a general tremulousness, a tottering
gait, a relaxed and unmanageable tongue, and a
heightened imagination.

AND THEIR TREATMENT. 129

The physical causes may embrace every possible
disease of the brain, from a primary congestion to a
terminal lesion of the substance itself. In searching
for the physical causes of mania, we must examine
the head, the thorax, and the abdomen. Likewise
we should consider the state of the sexual organs,
for diseases of the uterus and ovaries, with irregular
and suppressed menstruation, often accompany an
attack of severe mania.

Mania often follows in the wake of general fevers,
and their exhausting and irritating effects upon the
nervous system must receive a proper consideration.
Suppression of the normal excretions of the body
may sometimes result in a maniacal attack. Long-
continued illhealth, together with worry, and anx-
iety, and perplexity, and apprehensions of various
sorts, may tend to develop at first a general irri-
tability, and afterwards an exaltation of the mental
faculties that passes beyond the limits of ordinary
self-control.

Insufficient sleep is one of the greatest dangers to
mental health. The habit of getting up too early in
the morning is generally the offspring of necessity.
Those who are poor, and who are obliged to work
hard for a living, must, as a rule, by compulsion rise
early in the morning. By too early rising, I mean
the getting up of these unfortunate victims of cir-
cumstance before the mental and physical forces are
thoroughly recuperated from the exhaustions and
trials of the day before. This danger of early rising
comes not only to the farming classes, but likewise
to those who labor in the mills, and factories, and
stores of the cities. The gentleman of fortune and
the unworrying tramp are usually free from the dan-
ger of getting up too early in the morning, and are

130 MENTAL DISEASES

comparatively free from the invasion of insanity.
To avoid the 'danger of too early rising, the work-
ing classes should retire as early as possible in
the evening, in order to devote at least eight hours
to rest, and physical and mental refreshment. The
trouble with many is that they sit up late for
purposes of amusement or through the necessity for
toil, and then get up in the morning before they are
fally refreshed by sleep.

In a general way, we may state that mania may
result from any unusual shock or strain upon the
nervous system ; or it may come after any unusual
mental excitement in business, in politics, or in
religion.

Now, while we may easily recognize some of the
exciting or stimulating causes of mania as affecting
immediately the individual, I think we must go back
of the presence of worldly misfortune, and trace the
tendency to mental disorder through channels of
hereditary influence. No one doubts the fact of
resemblance in families of face and figure. How,
then, can we doubt the fact of inborn tendencies to
either mental steadiness or mental eccentricity?
There are those whose natural bent is toward inco-
herency of thought and action. Infants are bom
every day whose inevitable goal is that of insanity.
The toxic influence of wrong-living and wrong-think-
ing pervades their w^hole being while yet occupying
a chaotic residence in their father's loins.

The primary and subtle causes of maniacal excite-
ment should be careftilly studied and understood by
those who are to become physicians and teachers in
the world at large. The physician's advice should
be sought in every case of prospective marriage. By
restraining those who are unqualified for the duties

AND THEIR TREATMENT, 131

and responsibilities of propagating their kind, we
might, after a time, improve the temper and quality
of the human race. Correct methods of living
should be learned from wise doctors, and thus the
preparation in early life for future marital duties
may be made.

Lack of brain poise, brain strength, and brain
soundness at the outset, and lack of suitable mental
culture subsequently, are, we believe, the most pro-
found causes of this intellectual aberration known
to the profession under the significant title of mania.
These causes are but rarely recognized, and still
more rarely acknowledged. How much easier it is
to tell the mother that her daughter has become
insane through some real or fancied sUght put upon
her affections, than it is to say: ** Through your
own carelessness and wrong-living your child was
bom with a badly constructed brain." How much
more popular is that physician who declares that
the young man has studied too hard or worked too
much, than is the medical adviser w^ho, seeking the
real cause, plainly states that the brain of the victim
was bent at the outset, and never straightened by
judicious fostering in youth.

Forms

The variety of insanity known as mania has
numerous forms which we shall classify as follows :

1. General forms, — namely, acute, subacute (par-
anoia), and chronic.

2. Special forms, — ^namely, acute delirious, recur-
rent, periodic, and circular.

3. Peculiar forms named from supposed causa-
tion; to wit, traumatic, masturbatic, syphilitic,

132 MENTAL DISEASES

puerperal, hysterical, climacteric, tubercular, meta-
static, and post febrile manias.

4. Disputed forms, such as monomania and
moral mania.

5. There is also a class of manias which may be
designated by some peculiar sin or crime, such as
dipsomania, erotomania, nymphomania in women,
satyriasis in men, kleptomania, pyromania, etc.

Symptoms, Courses and Cases

We will now invite your attention to a considera-
tion of the symptoms and courses of those manias
classified under the head of "general." The others
will, by their names, denote their tendencies,
although we shall again refer to the most important
of them.

Acute Mania. — Acute mania is usually preceded
by a period of mental depression. This depression is
accompanied by a disposition to brood upon a
single, all-absorbing topic. Dr. Johnson, the great
English moralist, in his famous work entitled
**Rasselas,"has traced with a master-hand the slow,
sinuous advances of mental derangement. He says :
**Some particular train of ideas fixes the attention;
all other intellectual gratifications are rejected ; the
mind, in weariness or leisure, recurs constantly to
the favorite conception, and feasts on the luscious
falsehood, w^henever she is offended w^ith the bitter-
ness of truth. By degrees the reign of fancy is con-
firmed ; she grows first imperious, and in time des-
potic. Then fictions begin to operate as realities,
false opinions fasten upon the mind, and life passes
in dreams of rapture or of anguish. '*

Struggling against these ill-defined and misty
influences, the patient feels painfully the slow

AND THEIR TREATMENT, 133

gatherings of an unseen storm. He becomes anxious
and apprehensive, \srakeftil and haggard. A sense
of intolerable unrest pervades his entire being ; yet
he may for a time be able to conceal these sensations
from his most intimate friends by calling to his aid
all the reserve forces of self-control. Gradually sleep-
lessness occurs, and the appetite becomes capricious
and irregular. Dark, gloomy thoughts pervade the
mind even as damp vapors infest the valleys. Delu-
sions which he cannot banish creep in. The victim
thinks himself followed, and turns often to look at
his pursuers. He imagines that his life-long friends
are failing him. He begins to suspect that his food
is being drugged; that the medicine which he may
be taking for some bodily ill is potent poison ; that
he is being practiced upon by electricity; that the
air is full of baleftil odors. Charged with these false
beliefs his mind becomes a pent-up volcano, ready to
belch forth at the slightest provocation. The whole
current of life thus becomes gradually changed. The
victim's daily toil becomes a burden. Social pleas-
ures lose their fascination. The coming patient is
given over to seclusion and brooding. The slightest
cross to his wishes provokes him to fits of anger.
The least anxiety induces an ebullition of rage. He
neglects himself and becomes shabby in person. He
ceases to care for his family, and is inclined both to
jealousy and hatred of those who were formerly
dearer than life. Finally the great upheaval comes.
The bonds of propriety are suddenly snapped
asunder. The patient yields himself up to his delu-
sions, and is by them impelled to the commission of
the seven deadly sins. No description is adequate to
the practical reality. Honest men are transformed
into demons, ready for any criminal act. Pure

I

134 MENTAL DISEASES

women become shameless, obscene, hideous. Mania
is human nature unmasked and unrestrained. It is
a condition which shows up in lurid light all the
depths of total depravity. As mania develops in the
patient, wild, incoherent, bubbling monstrosities of
thought are begotten in the brain. These make
their presence manifest by impelling the sick man to
loquacious and unchecked babble. Incongruous as
each remark may seem to its precedent, there yet
runs a thread of continuity through the whole mass
of illogical reasoning, just as a red thread runs
through all the cordage of the British Navy. There
is a certain fixedness of ideas in spite of irregular
modes of expression. Each day brings a repetition
of the same thought, but often with original
rhetoric. Thus we observe truth in the classical
statement that there is method in the madman's
madness.

The physical condition in a case of acute mania
simulates, somewhat, the middle course of t3rphoid
fever, although there is less rapid failure of the life
forces. Where the mania is long established, the
appetite of the patient generally becomes good, and,
in fact, oftentimes it is ravenous. By the consump-
tion of large quantities of food the bodily strength
is greatly conserved.

Mania is a disease where daily and nightly phy-
sical and mental restlessness may be expected. In
typhoid fever while the patient is restless he is also
prostrated, and can usually be kept in bed. The
maniacal patient, in many instances, can be retained
in a recumbent position only with considerable diffi-
culty. Typhoid fever usually runs its course in
about three or four weeks. In mania, the patient
may continue in a state of profound excitement for

AND THEIR TREATMENT, 135

many months. The skin is commonly hot and dry,
with now and then a light, or sometimes a profuse
perspiration. The tongue at the outset is somewhat
coated with a yellow or yellowish-brown coating,
and the breath is indescribably offensive.

If mania progresses with marked severity, the
tongue becomes red at the top and edges, and in fact
is often red throughout, with a tendency to get
parched and brown. The lips are frequently dark
and cracked, and there may be sordes upon the
teeth. The face is drawn and haggard; the lines
of intelligence deepen; there is a scowl upon the
forehead, and the eyes are wild and glaring. The
pupils are generally dilated, though occasionally
contracted ; the pulse is somewhat quickened, and is
hard and wiry. It feels harder than the pulse of
ordinary fever. Occasionally the pulse feels like a
writhing whip-cord under the fingers. This is due to
the intensity of the heart's action, yet the tempera-
ture in such a case is but moderately elevated.

While the victims of mania often eat well, there
are some cases where eating is neglected, and where
the patient might starve through inattention. It is
the duty, therefore, of the physician and the nurse to
see that such patients are sufficiently fed. The
bowels are frequently inactive. The feces become
hard, and are discharged with difficulty. It is not
always easy to get a case of mania to pay proper
attention to the calls of nature. Thus tremendous
constipations sometimes arise. They may be relieved
by injections of warm oil. Ten or fifteen drops of
the mother tincture of Hydrastis may be added to
from four to six ounces of sweet oil, and that makes
a satisfactory injection for a bad constipation. The

136 MENTAL DISEASES

urine in mania is high-colored, often scanty, and
loaded with phosphates and urea.

The mania case is often dirty, lewd, and quarrel-
some. Some patients will eat their feces, and drink
their urine, or smear the body and the room with
the same. Some seek constantly to breed turmoil
about them. They grossly assault those who are
endeavoring to care for them, and if restricted, will
complain of their treatment. Maniacal patients
frequently bury the hatchet of truth, and dig it up
again only when their reason is restored.

The course of acute mania ranges from one to six
or more months. The length of time it may last
depends upon many circumstances, — ^upon the age,
sex, cause, period of incubation, number of previous
attacks, and other conditions. It is never safe to
predict a time at which an attack of mania will ter-
minate. The disease has no certain or probable
course. If it is a first attack, and the victim is
young and of good physique, with a tolerably
healthy family history ; and if the patient has elastic
spirits, and is readily impressed by favorable influ-
ences, the prediction of recovery may be limited,
with approximate accuracy, to from three to six
months. But since most of these cases are burdened
with complications, it is unsafe to make any positive
prognosis.

The following is a typical case of acute mania,
together with the results attained by treatment :

Mr. H. came to the hospital with a history of hav-
ing been excited recently at some religious meetings,
which, with suspected masturbation, was assigned
as the cause of his attack. He was of effeminate
-appearance, single, thirty-five years of age, and con-
sidered a careful and economical business man. Two

AND THEIR TREATMENT, 137

weeks before coming here he became flighty ; bought
things he did not need ; had the idea that he was
Christ; that he could cure all ills, raise the dead,
produce magical growth of plants, or do anything
else that occurred to his mind. He talked inces-
santly of these and other things, and as his ideas
flowed faster and faster, his tongue became unable to
keep up, and his words ceased to bear any coherent
meaning. He had hallucinations of sight and hear-
ing, and conversed by means of his soul with people
not present. For two and a half months he was
restless, talkative and destructive. Only now and
then could any of his remarks be interpreted into
anything like reason, yet his conversation was in-
fluenced by what occurred about him. He was often
twenty-four hours without sleep, and in spite of an
abundant nourishing liquid diet his weight fell off".
Toward the end of this period, short intervals of
calm occurred from time to time, to be followed in a
few moments or hours by a full return of the mania.
Then he became quiet, unless spoken to, when his
speech, after a few minutes, would become confused,
and this in turn passed away with the progressing
convalescence of his mind. Meanwhile his weight
increased; his color improved; he took an interest
in the life around him ; his cleanly personal habits
returned, and five months after his admission he left
the institution a well man. His remedies were Bella-
donna, Avena Sativa, Cannabis Indica, Arsenicum,
Hellebore, Stramonium^ and Hyoscyamus.

Among singular cases of acute mania I may give
the following :

A boy, eleven years of age, while passing through
a forest on his homeward way from school, per-
ceived a wildcat, and heard that animaVs blood-
10

138 MENTAL DISEASES

curdling scream. He ran home in g^eat terror. He
rallied from the shock, only to pass into a state of
exaltation amounting to acute mania. The child
was committed to the Middletown State Homeo-
pathic Hospital. Shortly afterward his two young
sisters, aged eight and nine, who had witnessed his
convulsive and maniacal outbursts, were similarly
affected, experiencing attacks of acute mania, and
were likewise committed to the hospital. All of the
children quickly recovered. While they were in our
charge it was necessary to keep them in separate
buildings for a time, that they might not see one an-
other, and thus suffer injurious excitement. When
considerably improved, they could associate with
one another without detriment.

Subacute Mania, — This is a mild but somewhat
persistent form of mania. The patient does not suf-
fer from those violent outbursts of passion, or long-
continued paroxysms of excitement so characteristic
of acute mania, but he cherishes the same general
delusions, and possesses, in a mild degree, the same
physical and mental peculiarities. The subacute
mania patient is cunning, self-poised, and deceitful;
and will often induce in the minds of the unwary the
conviction that he is not insane. When, however,
you touch upon his chief hobby, he becomes aglow
with suppressed excitement, which is most fre-
quently manifested by a certain muscular tremor of
the body, a hurriedness of speech, and an unsteadi-
ness of the voice like a person laboring under the ef-
fects of but partially restrained passion. At the
same time a glaring brightness of the eye is also ap-
parent. Such cases often fancy that every man's
hand is against them, and hence are exceedingly
jealous of their rights. These are the patients who

AND THEIR TREATMENT, 139

are always threatening to sue the hospital for
damages, who are constantly plotting to escape, or
who seek liberty by means of the habeas corpus.
They not infrequently deceive a jury of the laity by
their shrewd deceptions and apparent lucidity and
cogency of reasoning. These cases are generally
cleanly, bright, apparently cheerful, and while re-
tained in a hospital keep themselves under good self-
control. But their deceitfulness, tyranny over
friends, and unchecked impulses to wreak revenge for
fancied slights when at large, call loudly for proper
care, restraint and treatment.

Paranoia. — This term is derived from two Greek
words, Trapd, "beyond," and, voew, "to know or to
understand.*' It is a subacute form of mental ex-
citement characterized by delusions of persecution
and wrong. It is really a form of subacute mania.
The delusions are fixed and systematized, and do not
readily yield to any form of treatment. Paranoia is
usually the outgrowth of a high grade of imbecility.
Paranoiac 'patients come very near being wise, and
some would be able to carry in their minds a little
wisdom if they were not so horribly overburdened
with conceit.

"The delusions of the paranoiac may be reduced
to two, giving rise to the two recognized forms of
the disease, viz.:

1. Paranoia, with delusions of persecution,

2. Paranoia, with delusions of ambition or
grandeur.

The latter has been subdivided into :

(a) Religious paranoia,

(b) Erotic paranoia,

(c ) Jealous paranoia, etc.

Delusions of persecution and grandeur may be as-

^ I

140 MENTAL DISEASES

sociated primarily, or the ambitious delusion may
arise as a logical outcome and explanation of the
delusion of persecution. He believes he is persecuted,
therefore he must be great; or he believes he is
great, hence his persecutions. In either case his
greatness is assured, and his supposed persecutions
explained. His hallucinations do not by any means
always confirm his belief in his greatness, but if not
they usually add to his persecution. He hears vile
names applied to him, people on the streets mock at
him, the cough or sneeze of a passer-by is a signal of
his enemies, and means harm to him ; therefore, he
argues that he is a person of importance of whom
others are envious, and whom self-interest impels to
compass his sufi*ering and death. If he lives in a
monarchy some fancied resemblance to the reigning
family leads him to believe that he is of royal blood,
and thus an explanation is famished which satis-
factorily accounts for his persecutions, and at the
same time flatters his egotism and self-love."
(George Allen, M. D.)

If these patients begin to cherish delusions in
early life, and cling to them systematically for years,
they are not likely to recover. Sometimes if the
delusions develop later in life, and the patients are
favored with proper treatment at an early stage,
they may get well, or get enough better to become
quiet and useful citizens.

The following case from the hospital records is
given as illustrative of paranoia :

A. v., a captain in the civil war, wounded in the
leg at Gettysburg, while fighting desperately after
most of his men had left the field, was bom sixty-eight
years ago in Germany. He is a man who always
fully appreciated himself. He was wounded in trying

AND THEIR TREATMENT. 141

to hold a position after he had been ordered to re-
tire. His own opinions, activities and accomplish-
nients have ever seemed to him of prime importance.
In his younger days he was able to keep them in the
background, but after years of secret brooding over
w^hat seemed slights and insults, his self-esteem be-
came morbid, and delusions of persecution de-
veloped. He considers himself the most learned man
alive, and spends hours every day in committing his
theories to manuscript. He is a believer in evolution,
and declares that by finding a prototype of the
female hymen in a Florida fish, he has supplied the
cap-stone of proof; and this is only one of his many
pseudo-scientific discoveries. Before being committed
to a hospital for the insane he thought Mr. Cleve-
land, then president, stole his w^ar record, and hid it
in the White House, where he proposed to find it by
a personal search; and he ascribes his confinement
since then to continuous persecution in the hands of
powerful politicians. Still hope never deserts him;
such a man as he is cannot be downed ; and when
excited he regales his caretakers with promises of
chains and tortures when his friends, whom he has
summoned by his wireless telegraphy, shall come
with avenging hands to the rescue. At ordinary
times he is a quiet, gentlemanly old man, with a pen-
chant for making himself believe that young lady
employees are detained here involuntarily, and that
he is a knight-errant whose mission is to effect their
release. He refuses to take medicine, because he
thinks he does not need any. The medicine which
was presented to him he pronounces atropine, and
he is carefully keeping it to prove a conspiracy to
take his life by poison.

Chronic Mania. — Chronic mania is that form of

142 MENTAL DISEASES

insanity where the mental disorder has continued
for a considerable length of time. The term chronic
insanity, is a somewhat arbitrary term. The word
*' chronic" is derived from the Greek, ^ovfn^^ which
means "time." Consequently when we speak of
chronic insanity, we mean an insanity which has
continued for some definite or indefinite period.
Some writers claim that a case of insanity may
properly be called chronic after the disease has con-
tinued for a period of two years. Others deem those
patients chronic who have been insane more than
one year. The distinction is an arbitrary one, and
liable to excite discussion. For practical purposes, I
think we may call cases of insanity chronic after the
disorder has continued steadily for a period of two
years or more.

Chronic mania may terminate by running into
dementia, by death, or occasionally by recovery.
Dr. Rush says that "spontaneous recoveries now
and then occur after the disease has continued
eighteen or twenty years." (Aphorisms in Rush on
Mental Diseases). Dr. Clouston, with regard to
prognosis in mania, says: "Where there is exalta-
tion, there is hope. We do not pronounce a case
incurable for a long time; so long, in fact, as the
morbid brain exaltation lasts, and dementia does
not supervene. Concerning all cases of mania, so
long as intellectual activity continues, and mental
failure is not established, we should continue treat-
ment with a view to recovery." Nearly all cases of
mania may be classified as either acute, subacute, or
chronic.

The delusions of the chronic insane, though
cherished with tenacity, are generally modified or
toned down from the acute or subacute form. Some

AND THEIR TREATMENT. 143

of them are of a most curiotis nature. One of our
patients cherishes the sincere belief that she is an
^*atom of dust," and ridicules herself for speaking, or
eating, or performing any of the ordinary acts of life.
Another claims that she has not been born, and says
that her head is on fire. Still another can never get
the words right, and works herself into a frenzy over
words which get "all mixed up,'* according to her
delusion. This patient thinks at times that the
letters of the alphabet are all turned into s's and z'z,
and that it will take a lifetime to get them straight
again ; yet she always talks correctly, answers ques-
tions promptly and clearly, and is finely educated.
Another patient has for years persisted each day of
her life that she ** never stole Charlie Ross," and
^' never burned Chicago." Mrs. A. says she is "the
Saviour and the Judge of the quick and the dead."
Mrs. C. thinks she is fed with bread from heaven,
and water from the rock. These are brought to her
daily by birds with tinsel wings.

The insane man usually thinks that all things
center in himself. He is the hub of the universe, and
thinks and talks as if he were the only person
worthy of consideration on earth. Many of the in-
sane are egotistical. They do not fraternize well
with one another. They rarely listen to the de-
lusions of others, but prefer to consider and repeat
their own.

Special Forms

Acute Delirious Mania. — Here we have an intensi-
fied form of acute mania accompanied by delirium,
and terminating ordinarily in exhaustion and death.
A diagnosis of this disease is not always easy, since
many times it bears a striking similarity to acute

^ I

144 MENTAL DISEASES

mania. We may be guided, however, by the temper-
ature, which is higher in acute delirious than in
simple acute mania. The inception of this disease is
generally sudden, and the outbursts of fury are
severe and appalling. There are occasional remis-
sions of excitement, but they are simply lulls in the
storm, during which the tempestuous forces gather
renewed strength. The disease is marked by two
stages: First, excitement; and second, collapse.
During the first period the face of the patient wears
a peculiar expression which has been described as ** a
mixture of incredulity and maliciousness." The eyes
are brilliant and glaring, and roll about with great
mobility in their sockets. The mouth is filled with
tenacious spittle ; the lips and teeth are covered with
sordes; the tongue is dry and generally coated
brown, or it may be clean and bright red. The
patient will often grind his teeth for hours in succes-
sion (also general paresis), and he frequently mani-
fests a strong aversion to liquids. Sometimes when
hurriedly taking a drink, he w^ill bite a piece out of a
heavy tumbler as if it w^ere a cracker, and will chew
up the glass as readily as a boy can eat a candy
chip. The skin is dry and hot, and imparts a burn-
ing sensation to the hand. The patient keeps up an
almost continual motion. Frequently the hands are
kept moving in circles about the head. Hallucina-
tions of sight are commonly present, and the patient
often addresses some imaginary individual. Con-
stant and protracted sleeplessness almost always
prevails.

The prognosis in this form of mania is generally
unfavorable. In this respect the disease differs from
both acute mania and typhoid fever. The stage of
collapse comes suddenly, and is almost always very

AND THEIR TREATMENT, 145

brief. Now and then a case recovers, but this occurs
only when the disease is recognized at the outset, and
when prompt measures for relief are adopted. The
life forces must be conserved by judicious care, and
easily digested nourishment, and the administration
of carefully selected remedies.

Recurrent Mania, — In this form of mania the
patient is very excitable for a time, and then appears
to have a full remission of all symptoms of insanity •
But the invasions of disease are repeated at inter-
vals, varying in frequency from one month to two or
more years. A case is on record (but not at this
hospital) of a woman who recovered from recurrent
mania forty-seven times, and who finally died
during the forty-eighth attack.

Periodic Mania, — This is a subdivision of recur-
rent mania. It is named periodic from the fact that
the outbursts of violence recur uniformly at stated
periods, as every month, or every summer, or every
winter, or in the case of some females at every men-
strual flux.

Circular Mania, — Circular mania is a rhythmical
alternation of mania with melancholia. Sometimes
between the extremes of exaltation and depression,
there is a period of complete remission or recovery.
An interesting case of circular mania was long under
my personal observation. The case was that of a
lady patient at the hospital under my charge who
for years lived in the following manner: For four
weeks she would lie passively in bed, and no induce-
ment whatever could arouse her to any physical or
mental action. During this period she was much
depressed in mind, would scarcely speak, answered
questions only in monosyllables, and ate sparingly,
but slept a good deal. At the end of each period of

146 MENTAL DISEASES

decubitus she would brighten up, have an improved
appetite, become cheerful and talkative, and on the
day following the completion of this month of rest
she would leave her bed, dress and appear upon
the hall the most loquacious of women, the most
ceaseless in physical activity, and the most impe-
rious in her numberless demands. At times she
would become intensely excited, obstinate and mis-
chievous. During the winter season she was much
more inclined to violence than during the warm and
pleasant summer months.

Peculiar Forms

»

Traumatic Mania, — Among peculiar forms of ma-
nia we have the traumatic form. In the cases which
have come under our observation, we have noticed
that the leading characteristics are restlessness, in-
coherence, vivid hallucinations, mistaken identities,
muscular weakness, heat in the head, and at times a
besotted, half-drunken, dazed expression of the
countenance. As to the pathological states in trau-
matic insanity. Dr. Skae holds that there is a chronic
hyperemia of the brain and its membranes ; while Dr.
Blandford asserts that we have **to deal with a mi-
nute molecular change — a change which may be due
to contusion of the gray matter, caused by a blow
or a fall, and producing an alteration in nourishment
and growth of the part, in blood supply, or in the
nerves presiding over it.''

Clouston states that he has seen about twelve
cases of traumatic insanity in nine years ; and con-
cludes therefore that ** accidents to the head do not
loom largely in the production of the insanity of the
world." J. Crichton Browne, on the other hand,
suggests that brain injuries, inducing insanity, occur

AND THEIR TREATMENT, 147

at all periods of life, from forceps deliveries to the
accidents of old age. We believe that many of the
brain injuries sustained during childhood are for-
gotten ; and consequently when insanity occurs, this
subtle and remote cause does not figure in the
history of the case ; and in old age these injuries are
concealed by the pride of the victim. After a careful
inquiry as to the general experience of numerous
patients, we have come to the conclusion that many
insanities properly date their inception from a blow
upon the head, inflicted during the growing and
tender, or later periods of life, and resulting in
minute and long-continued pathological changes in
the brain. Almost all cases of epileptic mania are
aggravated by brain injuries which arise from the
tendencies of the primary disease.

We present a case of mental disease produced by
direct injury to the brain ; and likewise a case whose
recovery dates from an accidental but severe blow
upon the head. Thus we have what may be called
traumatic insanities, and traumatic recoveries.

The first case is number 2,207. Mr. W. E. S., aet.
18 ; occupation, laborer ; education, common school ;
habits, temperate; no record of insanity in the
family. When admitted the patient was in good
physical condition, and his history declared that
down to the date of his injury he had been a bright
boy.

About six weeks previous to his admission to the
the hospital, Mr. S., while standing on the top of a
ladder, twenty-six feet in length, picking apples
from a tree, fell to the ground, striking on the back
of his head. He was carried into the house uncon-
scious, and remained so for several hours. He re-
ntiained in bed only one day. From the time of his

148 MENTAL DISEASES

axicident to the time of his admission, he is said to
have spoken but two or three words. He could
not speak when admitted, but during his entire ill-
ness he was able to comprehend questions written
upon paper, and would answer these questions
readily and rationally in writing. In his writings
he stated that all spoken words sounded like noises
to him, but had no meaning. He could hear a low
tone of voice, but not a whisper. In writing answers
to questions, he did so quickly, and showed a clear
comprehension. He asked questions intelligently by
writing, and said that he had a dull, steady pain
from the base of the brain down the spine to the
small of his back, and this pain was aggravated by
any sudden jar. On examination, the spine from the
first lumbar vertebra to the skull was found to be
very sensitive to touch and pressure. He said that
exercise did not tire him, and for several weeks he
was allowed to do as he pleased. He spent much of
his time out-of-doors playing with a large New-
foundland dog which was much attached to him^
and which attended him when he came to the hos-
pital.

Five days previous to his admission to the insti-
tution, this patient became much enraged at his
mother who would not grant some request he made^
and he flourished a long knife and tried to injure her.
On being shut up in a room he broke the door and
was very violent. His friends then had him com-
mitted to the hospital under my charge. When
admitted, his pupils were normal in size, and the
reaction was natural. The tongue was clean and
firm, with no muscular tremor ; the pulse was 78 ;
the temperature 98.4°P. The patient weighed 150
pounds, and seemed generally in good physical state.

AND THEIR TREATMENT, 149

He had a good appetite, slept well at night, stated
in writing that the pain in his head had ceased, and
he deported himself like a bright, good-natured,
active boy. But he could not hear distinctly, and he
could not speak at all, although apparently compre-
hending everything that was written and placed
before him.

Here was a case of motor aphasia, or aphemia
-(can write but cannot speak), resulting from a blow
upon the head, with occasional attacks of maniacal
excitement; the excitement being displayed by rest-
lessness and ebullitions of rage, without any ability
to give articular utterance to his emotions or pas-
sions.

Although the patient had been allowed to walk
about as much as he pleased for nearly six weeks, we
concluded it would be better for him to remain quiet.
Consequently we placed him in bed, and kept him
there. The second day after admission he caught
<:old, and wrote on paper that his head hurt when he
coughed. Four days later, about 9 a. m. — he wrote
on a slip of paper, "headache," and gave it to the
attendant. About 11 a. m. the pain in the head had
increased, and at 11:30 a. m. he was rocking back-
ward and forward in bed with both hands pressed
tightly against his head, one being over the forehead,
the other over the occiput and upon the seat of
injury. His face was flushed, pupils dilated, and the
eyes deeply injected. While an assistant physician
was noting these symptoms, the patient suddenly
removed his hands from his head, looked up like a
person awaking from sleep, gazed about the room in
an inquiring manner, turned to the window, looked
out for a moment, then suddenly turning to the
-doctor he said : " Where in the devil am I ?" These

150 MENTAL DISEASES

were the first coherent words uttered since the in-
jury. This patient's mind went back to its normal
position with a snap, so to speak, just as a dis-
located bone returns to its socket when it is set by a
surgeon. On being asked if he did not know where
he was, he said: **Not in the least. I know I was
picking apples when the ladder broke and I fell,
striking on the back of my head. Oh, how it hurt!"
On being told that it was some weeks since the acci-
dent, and that he was in a hospital, he said : ** Why,
that was the eighth of October, what day of the
month is it now?" On being told that it was the
twenty-third of November, he replied: "To-morrow
will be Thanksgiving Day; a lunatic asylum is a
queer place to pass Thanksgiving Day." When told
that he had not spoken before since coming to the
hospital, he said: **I must have been good com-
pany." On questioning him he declared that he had
no memory of anything that had taken place since
his fall from the ladder. For six weeks, time had
been a blank to him. After he began to talk, his
headache lessened. He was kept quietly in bed, and
given hot milk and beef tea every three hours. The
headache and tenderness along the spine soon passed
away, and no symptoms of brain or mind trouble
returned. He remained at the hospital under obser-
vation for three months, when he went home in ex-
cellent physical and mental condition. While his
memory was dislocated for six weeks, he could, after
his recovery, remember distinctly all the previous
experiences of his life, and all new experiences, but he
could never recall any incident that occurred during
the six weeks mentioned.

The second case is No. 356. Mr. J. A. H., 24
years of age ; occupation, clerk ; education, common

AND THEIR TREATMENT, 151

school ; no insanity in family. He was suflfering with
the seventh attack of mania. He had been insane
(daring his last attack) about three or four weeks
previous to his admission to the hospital at Middle-
town. He had been in other hospitals six times, and
each hospital visit had lasted from three to eighteen
months. On admission he was noisy and restless.
The first night he did not sleep, but devoted his
energies to tearing up his clothes. He admitted that
he was addicted to masturbation.

The second day after admission Mr. H. was tear-
ing his clothes, talking loudly, and eating soap
whenever he had an opportunity. At three p. m. he
tried to swing on a gas fixture in a wash-room, and
turn a somersault through his hands; but as he
swung his feet up to his hands, the gas fixture broke
and he fell, striking his head and shoulders upon a
tile floor. He got up, walked about, and talked for
twenty minutes afterwards, when he became sud-
denly unconscious. His breathing was stertorous;
his pulse 80 and very strong; his pupils appeared
about normal in size. Soon after he became uncon-
scious, the face grew purple in color, and the muscles
of the right side of the mouth twitched ; the pupils
were insensible to light; the eyeballs insensible to
touch, and there was diverging strabismus. At 4:30
p. M. the right pupil was more contracted than the
left. At 6 p. M. the pupils were normal ; the pulse 80.
The patient was groaning, and he spoke confusedly
of feehng badly in the left groin. At 9:15 p. m. the
pulse was 72 ; the urine had been passed freely ; the
patient was very drowsy, with occasional muttering
delirium. On the following day the pupils appeared
normal ; the pulse was 80 ; the urine and feces were
voided with difficulty ; the patient was able to talk,,

152 MENTAL DISEASES

and complained of headache in the top of the head.
He slept most of the time that day. The next day he
seemed to have recovered very largely from the
effects of the fall, and on the following day, three
days after the injury, he talked and acted sensibly ;
and he continued to do so as long as he remained
under our observation. He remained willingly at
the hospital for about two months from the date of
admission, when he was discharged as recovered.
Three and a half years after he left the hospital, I
met his family physician who told me that this
patient had experienced no return of insanity, and
that he was one of the most active and reliable busi-
ness men in the town where he lived. I heard from
this case again, ten years later, and he was still do-
ing well.

Here was a case that suffered seven attacks of
insanity in a period of nine years. His previous
attacks had lasted from three to eighteen months
•each. The period of recovery ranged from six to
twelve months. He was entering upon his seventh
attack when he received the injury, and judging from
the past, his insanity should extend over a period of
iirom three to eighteen months. But this blow upon
the head apparently caused a recovery in three days,
and this recovery continued for at least ten years,
and, so far as I know, it has continued during the
past twenty-two years.

This case of recovery from insanity, by means of a
blow upon the head, is exceedingly interesting, on
account of both the suddenness and the permanence
of the restoration to mental health.

Syphilitic Mania, — This form of insanity is ac-
quired through indulgence with those who have the

AND THEIR TREATMENT, 163

syphilitic taint. It often springs from coarse brain
disease induced by syphilis.

Puerperal Mania. — Puerperal mania is simply
acute mania associated ivith child-bearing. Its
causes are indicated by its name. Sometimes
insanity comes on during pregnancy and before
childbirth. Again, it may occur within a few days
after delivery ; and once more, an attack may come
on several months after delivery, and during the
exhaustion of lactation.

This form of mania is caused by excitement or
anxiety, or by exhaustion from over-flooding, or
from protracted pain, or from the wastes of nursing.
And again, the patient may become exhausted from
the loss of sleep in caring for the child. As you may
meet such cases in your early general practice, we
will give you an example case of puerperal mania
which came under my notice :

Mrs. H. C. E., set. 27, was confined six weeks
before being brought to the hospital. Three days
after confinement she was attacked with puerperal
fever which lasted about one week. When the fever
subsided she seemed well mentally. Two days after-
wards, and twelve days after confinement, the
patient began to show signs of insanity. She was
excited most of the time; was obscene, religious,
noisy, destructive, and sleepless by spells. For a
short time she imagined herself wealthy, but she had
no fixed or continued delusion. The day following
her arrival at the hospital she was very noisy and
destructive. She repeatedly declared : "I am under
this flag; my ship is forty-five; I came here under
false colors.'* She mistook those around her for
persons she had known before; when food was

taken to her she broke the dishes ; was very violent,
11

164 MENTAL DISEASES

and seemed to have hallucinations of sight and
hearing which frightened her. The patient was
given Stramonium. After several days of excitement
and incoherency she became more quiet and better-
natured. Then she complained of pain in the head,
through the temples, and over the top. Her pupils
for sometime were considerably dilated. At first she
cared little for food, but afterwards had an excellent
appetite. Some weeks after admission she began to
talk quite freely to imaginary people. She also
heard voices, but what they said did not seem to
disturb her, as she was good-natured and jolly. On
account of her jolly delirium, her tendency to
destructiveness, and particularly her inclination to
remove all clothing, we gave Hyoscyamus, and this
remedy seemed to have a favorable eflFect for a time.
At length she began to menstruate, and had a
profiise flow of bright red blood. During her men-
struation she became more obstinate and pugilistic
than usual. Her pupils were largely dilated. On
account of her intense ugliness, and destructiveness,
and the dilated pupils, and the flow of bright-red
blood from the uterus, she received Belladonna. A
little later the patient was not only wild, noisy and
destructive, and inclined to remove all clothing, but
she began to smear herself and her room with feces.
She then had a slight period of depression, and while
depressed she inquired for her children and her
husband for the first time in several weeks. Then
she began to improve, and in about three months
after her admission she became quiet, pleasant, and
rational. She continued to gain steadily, and in a
little less than four months from the date of admis-
sion she was discharged as recovered.

AND THBIR TREATMENT, 166

This case was remarkable for the Yiolence of the
mental manifestations, and the great physical un-
rest. It is considered a rather unfavorable symptom
where the patient smears herself with feces, and yet
in spite of that the case recovered. Though noisy
and destructive and violent day and night for
several weeks, she was nearly all the time good-
natured. As we have said before, we have larger
hopes for a patient who is cheerful in spirits than
for one who is depressed and crying, or sullen,
morose, or obstinate.

Hysterical Mania, — This form of mania is prob-
ably a prolonged exaggeration of some hysterical
condition. Hysterical lunatics think they see visions
of the Saviour and the Saints, and receive special
messages in that way. Hysterical insane girls think
they give birth to mice and frogs, and they also live
on lime, and hair, and slate pencils. Sometimes they
indulge in hysterical convulsions, in morbid way-
wardness, in ostentatious attempts at suicide, and
in semivolitional retention of urine. Cases of hys-
terical insanity should be secluded from their friends,
and trained and disciplined and cared for until they
become stable in mind. (Clouston).

Disputed Forms of Mania

The disputed forms of mania, such as mono-
mania, moral mania, and the manias of criminal
tendencies, might all be classed under the general
head of subacute mania. These cases are generally
quiet and tractable when under discipline, and they
cherish more or less the specific delusions which are
characteristic of that form.

Under the influence of ideas of persecution or

156 MENTAL DISEASES

wrong, or impelled by a feeling that it is one's duty
to rob, pillage or destroy, we have subacute maniacs
who develop into kleptomaniacs or pyromaniacs.
In such cases we find imbecility of the moral nature,
together with a perversion of judgment, and an
impairment of will power. In these cases the pro-
cess of reasoning is at fault, the judgment is weak,
the will erratic, and consequently the intellectual
faculties bow before the fell influence of moral per-
versities. We must come, I believe, to consider in-
sanity as a unit. There is a trinity of forces in man
which tends to sane thought, moral speech, and
rational action — ^namely, the physical, the intel-
lectual, and the moral forces. If the physical force
is vigorous, if the intellectual force is keen and clear,
if the moral force is sensitive and true as the needle
to the pole, then you will have sane thought, sane
action, and sane conduct. These forces are united
as closely, and as firmly interwoven as the Trinity
of the Universe. When one is affected, the others,
by contact or impression, are also affected. Break
down the physical by disease, and you have per-
versions of both the intellectual and the moral
forces. Hence we should dispense with the old-time
dogma that a patient may be insane upon one
point, and sane upon every other point. While this
may appear to be the case, as a matter of fact if
the man is insane upon one point, this taint of in-
sanity affects generally his thoughts, and motives,
and actions to a certain degree.

Pathological States

The pathology of mania is obscure, and as yet
but little understood. The investigations of Edward

AND THEIR TREATMENT, 157

Long Fox, M. D., F. R. C. P., in this direction, have
been carefully made, and we take pleasure in quoting
briefly from his Pathological Anatomy of the nervous
centers. He says: ** Clinical- observation, as well as
pathological research, leads us to consider lesions of
the vessels as at once the primary and the most im-
portant of all the cerebral changes in mania. It is
this capillary distention, this hjrperemia of the
cortical substance of the brain, that is the chief
lesion in acute mania. This hyperemia will generally
affect the pia mater, and, I believe, especially the pia
mater of the convexity.'*

Rindfleisch says that the cortical hyperemia will
here cause a sort of stasis; this, again, leads to
overdistension, then to atony of the vessels. This
hyperemia of the pia mater and the cortex may be
shown merely in a slight tinge of redness ; more fre-
quently, however, its previous presence is manifested
by its results. These are extravasations, diffuse
encephalitis, affecting especially one layer of the
cortex, and pigmentation ; and if the hyperemia has
been long continued, or has frequently occurred,
further changes are found to have taken place in the
vessels themselves.

The extravasations may take the form of puncti-
form hemorrhages, but more usually the extravasa-
tion has not absolutely reached the brain matter,
but exists in the form of dissecting aneurisms of the
small veins. Besides these minute aneurisms we find
various dilatations of the smallest vessels, causing
alterations of shape of variable intensity. Dr. Buck-
nill thinks that in acute mania extravasations of
blood are chiefly in the pia mater.

Greding states that "the choroid plexus was
healthy in only 16 out of 216 cases of insanity, and

168 MENTAL DISEASES AND TREA TMENT.

that out of 100 maniacs 96 showed a choroid plexus
that was either thickened or full* of hydatids; by
hydatids he doubtless meant serous cysts. The in-
flammatory condition met with in mania is usually
confined to the middle layer of the cortex. The ex-
ternal layer is occasionally affected, this layer of the
cortex coming off" in patches when the pia mater is
removed, and bearing the appearance of ragged
ulcerations of the external portion of the brain." A
similar condition exists when the brain of a general
paretic is denuded of its pia mater covering, but from
a different cause. In paresis there are inflammatory
adhesions of the pia mater to the cortical substance,
and when the former is peeled off it brings with it
small particles of the cortex, leaving a brain surface
which appears to have upon it Ane ulcerations. In
mania the second layer of cortical substance being
somewhat softened, when the pia mater is removed
there is sometimes the appearance of a rougher and
more general breaking up of the convolutions of the
brain than obtains in paresis. In paresis the parti-
cles that come away are like pin points; in mania
the cortex, if it clings at all to the pia mater, will be
removed in patches.

LECTURE VII

Dementia

We shall to-day discuss that form of insanity
known as Dementia. The term is derived from two
Latin words, de, *'from," and /nens, **mind/' The
expression, therefore, means strictly "out of mind."
It signifies, indeed, that the human being, thus
bereft, is, to a considerable extent, in a state of the
most deplorable mental poverty.

In discussing such a subject, we enter a field that
is a vast desert waste. The paths across this field
are strewn with the wrecks of early hopes, of joyous
prospects, and of fruitless designs. The desert before
us is a tiresome plain, unpeopled save by the ghostly
images of uncertain recollection. Desolation is the
ruling god of this desert, and destruction of men-
tality is his desperate and continued aim. And yet,
in every desert there are some bright spots where,
nourished by some hidden fountain, the perennial
verdure springs. These gardens in the midst of the
sand are called oases, and they signify that which is
wonderfiil, and excellent, and unexpected. In the
desert of dementia we have discovered some bright
and hopeful spots. We have seen the light of
recovery flash unexpectedly across the dark and
gloomy pathway of some apparently hopeless
victim. There are more oases in the distance await-
ing attention, and Science, ever progressive, bears
aloft her brilliant torch, lighting the path to future
discoveries, and future amelioration of disease.

160 MENTAL DISEASES

Esquirol states that dementia deprives men of the
faculty of adequately perceiving objects, of seeing
their relations to various things, of comparing them,
or of preserving a complete recollection of them;
whence results the impossibility of reasoning cor-
rectly. Demented persons are incapable of reason-
ing because external objects make too feeble an im-
pression upon them, because the organs of trans-
mission have lost a part or all of their energy, or the
brain itself has no longer sufficient strength to re-
ceive and retain the impression thus transmitted to
it. Hence it necessarily results that the sensations
are feeble, obscure and incomplete. Being unable to
form a just and true idea of objects, these persons
cannot compare them, or exercise abstraction or
association of ideas. They are not capable of suf-
ficiently strong attention; the organ of thought
has not energy enough ; it has been deprived of that
vigor which is necessary for the integrity of its fiinc-
tions. Hence the most incongruous ideas succeed
each other ; they follow without order and without
connection. It seems as if unreal expressions were
whispered to them by unseen tongues, and these ex-
pressions are repeated by the patients in obedience
to some involuntary or automatic impulse. Here we
find examples of unconscious cerebration of a rare
and interesting type, or rather a consciousness
evolved from within and unrelated to association
with external things, except through the medium of
former impressions.

One great point of difference between dementia
and idiocy and imbecility is that in both the latter
the faculties are imperfect, while in the former they
are simply enfeebled. Idiocy is a congenital absence
of both cerebral and mental power. It is amentia^

AND THEIR TREATMENT. 161

"without mind/' Imbecility means a checked or
arrested development. A child may have fair or
moderate mental powers until the age of six, eight,
ten or more years. Through disease or emotional
disaster or injury, a shock is produced upon the
nervous system, and this shock is sufficient to check
all future mental growth. Hence an imbecile who is
forty years of age will have the mind and capacity
of a child of six or ten years of age. In fact, if a
child becomes an imbecile at ten, he will by and by
only manifest the feeble powers of a child three or
four years of age. That is, from the time the im-
becility fairly begins there is a tendency toward
degeneration. Still, there are some imbeciles who
retain a special faculty for remembering names^
or for adding up figures, or for playing upon
some musical instruments. Now dementia, meaning
"out of mind,*' is a condition of mental failure or
infirmity, resulting after the mental powers have
been developed or ripened to a fair extent. Dr.
Winslow describes dementia as "a general enfeeble-
ment of the intellect, and in some cases an apparent
abolition of all. mental powers.'' Mental power is
always weakened in dementia, but comparatively
seldom is that power utterly lost. We are speaking
now of confirmed cases.

Forms

Dementia may be classified in a general way as
primary and secondary. Primary dementia is a
disease which comes on independently of any other
form of insanity. Secondary dementia follows in
the wake of some other form of insanity, chiefly
melancholia or mania; and if this condition con-

162 MENTAL DISEASES

tinues until the case is hopeless, it is then called
terminal dementia.

Dementia may be either acute or chronic. That
is, it may come on suddenly and with sharp manifes-
tations, or it may gradually develop into a hopeless
and long continued aberration.

Primary dementia may be sudden or gradual in
its onset. Among the young and the poorly
nourished, an attack of dementia is likely to be
sudden, and then it is called acute primary dementia.
Senile dementia (the dementia of old age) may be
primary. That is, it may come on without any
previous attack of any form of insanity, or it may
come on so gradually that when actually observed
and brought to the notice of the physician it is, to
all intents and purposes, a chronic disease.

To primary and secondary dementias, with either
acute or chronic tendencies, we may add, as special
forms of this disease, masturbatic dementia, syphi-
litic dementia, epileptic dementia, organic dementia,
alcoholic dementia, katatonic dementia, and senile
dementia.

Causes and Symptoms of Acute Dementia

I now desire to call your attention to acute
dementia, a form not common, but nevertheless
interesting, because it afifords under proper care
strong hopes of recovery. It is to be distinguished
from melancholia with stupor. The diagnostic dif-
ferences were pointed out in my lecture on melan-
cholia.

From the writings of J. Crichton Browne, as well
as from our own observations, we learn that acute
dementia attacks both sexes, but females in a larger

AND THEIR TREATMENT. 163

proportion, though perhaps in a milder degree than
males. It is essentially a disease of youth, being
rarely seen in patients beyond thirty years of age,
and it seems, indeed, to be often dependent upon ex-
hausting influences operating at a period of rapid
growth. Children whose powers are overtaxed at a
time when the process of development is going on,
and when nutrition has not only to repair tissue
waste, but is also obliged to contribute to the
formation of new morphological elements, often fall
into a state resembling idiocy, in which they are
dull, sullen and depressed. And the children who are
thus affected by acute dementia are not always
those who have displayed extreme quickness of intel-
lect, coupled with nervous instability, who have
been clever and fragile, or who have inherited a pre-
disposition to insanity. On the contrary, they are
often those who have possessed only commonplace
abilities, who have been robust dunces, and who
have come of a perfectly healthy stock. For it is a
peculiarity of acute dementia that it is less fre-
quently connected with an hereditary taint than
perhaps any other form of mental aberration. How-
ever diverse and multiplied the causes enumerated
by some, we believe that neurotic tendencies have
been assigned a prominent place among them; but
that, perhaps, has arisen from force of habit rather
than from accurate observation. Neurotic tendencies
are the parents of such a multitude of evils that it
seems one can scarcely be wrong in affiliating with
them a malady having such a striking family re-
semblance to their acknowledged progeny. But
minute inquiry will hardly warrant such a proceed-
ing; for out of many recorded cases of acute
dementia, the histories of which were satisfactorily

164 MENTAL DISEASES

trax!ed, there were only about twenty-five per cent,
in which an hereditary proclivity to mental or
nervous diseases could be discovered. In most of the
cases there was, so far as could be ascertained, an
entire freedom from any such morbid impregnation.

It is not, of course, asserted that this disease may
not have its roots in ancestral mold. What is al-
leged is that it far oftener grows out of superficial
and individual conditions, and that they themselves
are sufficient to account for its phenomena, without
referring back to any hypothetical inheritance. In-
deed, strange as it may sound, it has sometimes
seemed that the absence of any neurotic inheritance
was favorable to the development of acute dementia
when its immediate causes come into play. These
causes, such as debilitating occupations or insuffi-
cient nourishment, when operating upon neurotic
subjects, have appeared to lead up to other dis-
orders, to melancholia or mania, whereas, when act-
ing upon more stolid beings, they have induced a
blunting of the mental powers, or acute dementia.

It might be inferred, from what has just been
said, that acute dementia is oftener due to physical
than to moral causes, and that inference would be
correct.

Moral impressions of a deleterious nature or in-
tensity act more powerfiilly upon sensitive beings
than upon those who are duller and steadier, and
consequently they are not very influential over that
class from which acute dements are drawn, unless
physical conditions have previously produced pros-
tration. Seldom do we hear of acute dementia being
brought on by a fiight, or a disappointment, or a
joyous surprise, unless a state of extreme debility
has existed when the emotional shock happened.

AND THEIR TREATMENT, 165

The one moral cause which is eflFectual in inducing
this disorder is monotony of thought and feeling, or
mental inanition. Man cannot live on bread alone.
His dietary must be varied, and if it is not he be-
comes starved as eflFectually as if he were on short
allowance. The human mind demands variety as
the necessary and imperative spice of life, otherwise
the mental forces fall into a condition of "innocuous
desuetude. *' Under various conditions of life, where
new impressions and ideas are not supplied, and
where a tedious uninteresting routine is inevitable,
does failure of. mental power occur. This is espe-
cially the case when the deprivation of new impres-
sions and the imposition of new restrictions are co-
incident with a period of mental evolution when the
growing mind is greedy of nourishment suited to its
wants.

Children who are sent at an early age into facto-
ries w^here they see brick walls and hear the same
noises from machinery day after day and year after
year, and where their work consists of muscular
movements requiring close attention, often pass into
a condition of acute dementia. Young prisoners in
jail sometimes suflFer in the direction of mental weak-
ness from the wearisome monotony of their lives.
Sailors stationed long at one place, where they ex-
perience simply the rolling of the ship and the rum-
bling of the surf, become filled with a sense of tedium,
and frequently have attacks of acute dementia.
Factory life, prison life, and stationary sailor life are
inimical to mental health, and tend to produce un-
natural weakness of the faculties. But the failure of
l)rain force must not be charged to one cause alone.
The majority of such cases arise, not only from mo-
notonous existence, but also from being poorly fed

166 MENTAL DISEASES

and indifferently housed. A lowered vitality caused
by poor food and hard work prepares the victim
most surely for the inception and growth of thig
grave malady.

Acute diseases, such as typhoid and other fevers^
have sometimes acute dementia among their sequelae.
It is also brought on occasionally by protracted
diarrhea, by bleeding piles, by leucorrhea, by men-
orrhagia, or by any severely exhausting and deplet-
ing disease. It may even derive its origin from
malaria or atmospheric miasma. It follows also in
the wake of alcoholism, gluttony, and masturba^-
tion, even as sharks follow ships that have corpses
on board.

But however induced, acute dementia makes its
actual invasion in one of two ways :

(1) It either steals over the patient by gradual
and at first almost imperceptible encroachments for
a few days ; or (2) it is ostentatiously ushered in by
an attack of excitement. In the first case some slips
of memory, some relaxations of attention, some ex-
pression of wandering thoughts, some moments of
blank bewilderment, are its earliest harbingers;
while in the second case an outbreak of fury, wild
bursts of laughter, swift meaningless movements of
the arms and head, and the giving forth of broken
disconnected sentences are the symptoms which an-
nounce its presence.

When once established in any way this disease
manifests itself by a greater or less suspension of the
psychical activities. Impressions are slowly trans-
mitted to the mind, and are imperfectly assimilated,
so that only a dim knowledge is obtained of external
things or events by the victim of dementia. Com-
parison is suspended, imagination has abandoned its

AND THEIR TREATMENT, 167

creative work, desire which in health surges so
tumultuously in the human breast now scarcely
moves within. AflFections and passions are dormant,
and the will is destitute of strength. This inward
mental inability is outwardly expressed in modifica-
tions of physiognomy, in gait, and in conduct. The
countenance wears a perplexed and vacant expres-
sion ; the attitude betokens lethargy or irresolution ;
the voice loses its accustomed tone, and the limbs
perform their duties with uncertain eflfort. The
patient is sullen and self-absorbed. If spoken to, he
gives no heed to what is said. His memory becomes
impaired; his command of language is reduced to
the minimum ; he performs his work, if at all, in a
slovenly and careless way. Most frequently all
labors are given up, and all exercises are renounced.
At this stage some curious exhibitions of the imita-
tive faculty and automatic muscular activity are
sometimes seen. A girl acutely demented was asked
repeatedly and forcibly : ** What is you name ?'* Be-
ing awakened and stirred into activity, she at last
cried out ** Elizabeth,*' and from that time for a
whole month following, when spoken to, she
screamed ** Elizabeth. *' In the same way, if patients
of this class are made to walk or run, they will con-
tinue to exercise automatically until they are
stopped. A patient will sometimes feed herself in
this way : A plate filled with chopped up food is put
in the proper position, a spoon is put into the pa-
tient's hand, and then the patient is made to dip the
spoon into the food and convey it to her mouth.
After doing this for a few times, she will go on auto-
matically and empty the plate. (Browne).

When acute dementia is of a severe type, the
mental state becomes one of profound stupidity^

168 MENTAL DISEASES

Comparison is abolished, memory is a blank, lan-
guage is lost, the sentiments are lifeless, the will is
palsied, and even the normal wants are not attended
to. Organic existence alone remains. The sufferer is
indifferent to all that is taking place around him.
Pricking or pinching the skin does not cause signs of
pain, nor does tickling produce responsive move-
ments. The patient will sit or stand for hours in
one position, lacking spontaneity of purpose to
change it. Now and then a species of catalepsy is
observed in these cases. The limbs remain for a time
in any position in which they may be placed; the
body in any attitude in which it may be thrown. If
the arms are raised above the head they will be held
there perhaps for an hour. Such an effort would
cause intense suffering to a healthy person, and yet
in these demented cases there is no great rigidity of
the muscles. The limbs are flaccid, and are readily
ffexed and extended, and it is remarkable that after
being long held in positions in which great resist-
ance to gravitation must be exerted, they are still
free from stiffness.

Of the bodily S3ntnptoms of acute dementia, those
connected with the circulatory system are most
prominent. They consist of feeble action of the
heart, small and almost imperceptible pulse at the
wrist, and passive congestion of the extremities.
The hands and feet are cold, and have a bluish-red
color, which disappears under pressure, leaving a
patch of pale skin; but the color speedily returns
when the pressure is removed. This coldness and
blueness is very striking, and is often accompanied
by considerable swelling. The hands and feet are
^sometimes affected by diffuse chilblains which form
and persist even during summer, and when the ex-

AND THEIR TREATMENT, 169

tremities are kept Tvarm, and wrapped in cotton
wool. There is often edema of the joints. The face
has a puflFed and livid appearance. When excitement
comes on in the mind of the dement, there is gen-
erally active flushing of the face and heat of the
head. The pupils in acute dementia are more or less
dilated, and somewhat inactive. The respiration is
quite shallow; sometimes the patient can scarcely
be seen to breathe. In advanced stages of the dis-
ease, there is liability to edema of the lungs. The
temperature in the axilla or rectum is generally
about normal, but in the chilled hands it has been
known to fall as much as ten or fifteen degrees,
Fahrenheit, below the normal standard. The tongue
is tolerably clean; sometimes swollen and pale in
color, and bears the imprints of the teeth at the
edges. (Browne and others). There is almost al-
ways a copious flow of saliva, and sometimes the
amount secreted and poured out is very great. As
much as a pint of saliva has been collected in five
hours firom one case — a very fair record of sap
exudation from a human maple tree ! The appetite
is generally good, if pains are taken to feed the
patient properly. Now and then the food is rejected,
but with as little sign of nausea or emotion as a child
manifests when it throws off its surplus of milk.
The bowels are frequently constipated, but occasion-
ally an exhausting diarrhea supervenes. In females
who are attacked with acute dementia there is gen-
erally amenorrhea, and sometimes leucorrhea; but
the process of excretion from the membranes, except
the mouth, seems to be checked. The female patient
is apt to become excited at the time when the men-
strual flux should occur.

Upon recovering from acute dementia, the patient
12

170 MENTAL DISEASES

finds a great hiatus or vacancy in his memory. He
has passed through the "valley of the shadow of
death/' and the shades have rested like a black
mantle upon his mind. His soul has been laved in
the sullen waters of Lethe, and perfect oblivion of
his sufferings is the fortunate result. In melancholia
with stupor, you will recollect, the melancholiac is
cognizant of every event, and remembers with clear-
ness the details of his perilous voyage through the
tideless, and sunless, and moonless slough of despond.

While w^e shall in a subsequent lecture enlarge
upon the treatment of these cases, we may tell you
here that the prone position in bed, to favor easy
circulation, and an abundant liquid diet, warm
clothing, and appropriate medication, are essential
to successful treatment.

Chronic Dementia. — We come now to consider the
phases of chronic dementia.

** lyast scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everjrthing.'*

The **sans everything'' to which Shakespeare
alludes is the sad and hopeless obscuration by time
or disease of the once bright, vigorous, scintillating
mental powers of exuberant and lusty youth.

Ben Johnson was once called upon to admire a
beautifal palace, but he growled at his companion
and urged him to hurry on, saying : " It is the sight
of such things as these that makes death horrible."
A contemplation of the ravages of dementia excites
a horror of existence, for it reveals a life full of grand
possibilities shorn at the last of every vestige of
mental cheer ; and it proves w^ith crucial force that

AND THEIR TREATMENT, 171

Kving with such deprivations in prospect is a most
solemn and trying thing. It is a solemn thing to die,
but, as Mrs. Partington says, "it is a good deal
solemner to liTC.'' But when we are brought face to
face with the unfortunate physical wrecks of
humanity, we are compelled by duty not to shrink,
but to examine carefully the sources of the wreck,
and to patch it up, and make it more comfortable
and habitable for its spiritual occupant, if possible.

After the disappearance of a severe attack of
acute mania, the effects of the shock are sometimes
visible in a certain condition of mental weakness
without actual intellectual disorder. The force of
character seems to have been snapped, and the finer
moral and esthetic feelings, which are the bloom of
culture, are abolished. The physiognomy has lost
its highest expression, and the individual presents
the appearance of a certain childishness. This is one
end of the scale of degeneration, but at the other the
mental powers are almost obliterated, the acquisi-
tions of the past being completely blotted out.
There is no interest in the present, and the patient
leads a merely vegetative life. Between these two ex-
tremes of slow weakness on the one hand, and
absolute mental failure on the other, we note every
shade of transition from strength to helplessness.

The countenance of the chronic dement no longer
expresses any fixed passion. There is a want of
harmony, or, as it were, a dislocation of the feat-
ures, and the most that is manifested is the shivered
expression of a passion, or the shattered wreck of a
smile. There is a corresponding imbecility on the
motor side. Some can continue their former occupa-
tion, or can do a little simple manual work; but
there is no sharp energy impelling to action. Not

172 MENIAL DISEASES

infrequently the industrious breadwinner of a large
family concludes, in a condition of dementia, his
busy industry on earth, by gathering bits of stone,
or pieces of glass, or wood, or any small, light, mov-
able objects that come in his way. Strange propen-
sities of all kinds are exhibited, as, for example, to
sit on the floor doubled up like a jack-knife, to stand
or crouch in a particular comer, to walk backward
and forward for a certain distance on a particular
strip of ground, to fantastically ornament the per-
son with feathers or flowers, or to repeat some par-
ticular phrase. A patient will get hold of a delusion
and repeat it automatically for days, and weeks,
and years. Hallucinations and illusions of the ex-
tremest kind are frequent, and tend to sustain the
delusion. One woman nurses as her child a lump of
wood decked in rags ; another person, whose singu-
lar movements seem unaccountable, is busy spinning
threads out of sunbeams, while a third continues the
most violent movements of his arm in order to pre-
vent the motion of the universe, or of his own blood
from coming to a stand. The mood may be of surly
depression or of more or less exaltation.

The bodily health is usually good, the patient fre-
quently getting stout as the active symptoms of
mania or melancholia subside into the calm of
dementia. Some patients suffering with chronic
dementia may be made to work, but they require
most careftil guidance.

The end of chronic dementia is usually death.
Occasionally a recovery takes place during the onset
of some acute disease. One case of four years' stand-
ing, and apparently hopelessly demented, recovered
his mental powers during a severe attack of tonsil-
litis. During this attack his temperature ran up to

AND THEIR TREATMENl, 173

105°F, and lie became delirious and talked in a ram-
bling and muttering manner. The inflammatory
conditions were remarkably intense. When they sub-
sided, the mind was clear, and the patient talked
quietly and rationally. He continued to improve for
several months, and finally recovered and returned
to his home, and resumed his work as a blacksmith.

This man's memory of events which occurred dur-
ing his dementia was completely obliterated. He
experienced four years of mental obfiiscation. After
recovery, his memory of facts and events, which had
been presented to his mind before his illness, was as
clear and strong as ever.

We have dwelt at some length upon acute and
chronic dementia. We will now consider, briefly,
some of the special forms of dementia due to par-
ticular or specific causes.

Masturbatic Dementia. — This form of insanity is
a result of that perversive and brain-impairing vice
familiarly known as *^ self-abuse.'' Sometimes a
person addicted to this unfortunate habit will suffer
with remorse to the extent of developing mild or
acute melancholia. And again, the victim of mastur-
bation may pass into a condition resembling sub-
acute mania, where the patient is sullen, irritable,
suspicious, and often thinks himself the victim of
some conspiracy or plot to injure him. But all cases
of masturbatic insanity eventually terminate in
dementia, unless cured or relieved of this deplorable
habit.

In patients suffering with masturbatic dementia,
we find, as a rule, but very moderate intellectual
powers, and especially are the forces of the will weak
and erratic in their operations. The animal pro-
pensities are strong and unrestrained. These persons

174 MENTAL DISEASES

are frequently of a religious cast of mind. Indeed,
one of our patients thus afflicted was in the habit of
saying his prayers, and of masturbating at the same
time. It may seem almost sacrilegious to refer to
such a fact, but it is proper that you, as physicians,
should be put upon your guard, and when you sus-
pect a given case of masturbating, you should not
be diverted from your investigations by the assur-
ances of the parents that the boy "is very good, and
says his prayers regularly.*'

The treatment of masturbatic insanity must be
moral, medical, dietetic, and hygienic. The proper
course to pursue is to carefully examine the sexual
organs, for the purpose of discovering abnormalities,
and if such exist an operation should be performed.
The boy should be circumcised, while, if necessary,
the hood should be removed from the clitoris of the
girl. Then by keeping the parts clean, the source of
irritation may be dispensed with, and the disposi-
tion to masturbate may be cured.

These patients should be taught the folly of their
actions, and at the same time they should be made
to feel that such an unwise use of God-given powers
does not constitute the unpardonable sin, nor pre-
clude the possibility of recovery and usefulness.
They should be encouraged by their family physician
to leave off bad habits, and likewise to abstain from
too much remorse.

Those addicted to unfortunate personal habits
are generally seclusive, and inclined to hide away
from everybody, especially from those of the oppo-
site sex. The lives and the habits of such patients
should be changed. They should be lifted from their
settled grooves of thought and action. They should
be taken from their books, their prayers, and their

AND THEIR TREATMENT, 175

solitude, and placed among genial and active people
of both sexes. These patients often profess a great
love for books. They retire to their rooms or to
some secluded forest shade ostensibly for study, but
in reality to indulge in lecherous imaginings, le\7d
thoughts, salacious efforts, and peccant practices.
They should not be allowed to dream or dawdle
themselves into dementia, but they should be stirred
in other directions, and elevated to better and nobler
things. Their energies should be restrained, and
stored up for future drafts established by the wise
and glorious economy of nature. Farming, herding
cattle on horseback, engaging in railroad enterprises,
mining, or any work that is hard and reasonably ex-
hausting to the physical forces, are the proper chan-
nels of toil for such cases. Out-door air, both in
sunshine and in storm, is a necessity ; and plenty of
plain food, and a hard bed to sleep on at night, and
constant association with those who are clear-
headed and watchful, are likewise demanded.

Syphilitic Dementia, — ^This form of dementia some-
times supervenes among those who have led fast and
disreputable lives. These cases are generally hope-
less, although death and other unfavorable symp-
toms may be postponed or mitigated by appropriate
medication. Syphilitic dements usually have gummy
deposits or tumors in the brain. These may produce,
besides loss of memory or loss of sight, paralysis of.
one or both sides of the body, and finally a series of
convulsions in which the patient dies. It is said that
almost every case of epileptiform seizure occurring
after the age of forty is due to a neurosis dependent
upon syphilis. Traumatic injury may, of course,
produce some cases of epilepsy after middle life.

Epileptic Dementia, — Epileptic dementia frequently

176 MENTAL DISEASES

foUo^Bvs a long continued series of epileptic fits. Vic-
tims of epilepsy are quite apt to be depressed or
melancholy at times, or again maniacal in their
speech and action. But at last they nearly all be-
come more or less demented. Such cases require
close care, good nursing, light diet, and such sympa-
thy as their helpless and deplorable state demands.

Organic Dementia. — Organic dementia is an en-
feeblement of the mental powers, complicated Avith
or supervening upon a paralysis of one or both sides
of the body. It is usually a disease of middle or
advanced life. It follows frequently an attack of
apoplexy, or it may occur after long continued glut-
tony or drunkenness. It may arise from syphilitic or
other tumors of the brain. It may owe its origin to
excessive sexual indulgence, or to excessive care, anx-
iety or overwork. Even an uncontrolled fit of anger
might induce it. Organic dementia is the result of a
marked and positive brain lesion. Therefore but
little hope of a permanent recovery may be indulged
in. However, as the lesion is commonly local, it
may, with good care, be partially relieved. Nature
is always on hand after every local injury to the
system with a powerful "work gang,'* and the task
of repair and clearing up the debris is sometimes
happily and unexpectedly accomplished. Even if the
channels of thought and action are clogged, new^
channels may be opened. Collateral circulation may
take up and perform successfiiUy the work of nourish-
ment, even where a main artery has been plugged by
an obstructing embolus. Hence we should be un-
remitting in our efforts to relieve cases of organic
dementia, for some cases may be materially helped^
although the vast majority can never recover.

Alcoholic Dementia. — This form of dementia is

AND THEIR TREATMENT, Vtl

produced by the protracted use of alcoholic stimu-
lants. In this form the failure of mental power is
not so marked as in some other forms ; but the de-
plorable feature in these cases is that the disease is
self-induced, is largely avoidable, and, worst of all, it
strikes down some of the strongest and best men the
world has ever known.

Remedies for the relief of alcoholic dementia are of
little avail so long as the exciting cause continues;
yet a too sudden withdrawal of long continued ac-
customed stimuli might result, in some instances, in
a still deeper dementia. Therefore, the physician in
treating such patients needs profoundest wisdom
and ripest judgment if he would do what is really
best for his case. Probably the wisest thing you
can do for the welfare of the community is to warn
the young against excesses of all kinds. The last
and bitterest result of overindulgence in strong
drink, or in any other excess, is an engulftnent in the
yawning pitfall of dementia.

Katatonic Dementia. — Patients affected with this
form of dementia repeat constantly and deliberately
the same sentence or phrase. For instance. No. 1659
says: "I think my name is E. E. W. My own dear
mother, who was kind and faithful to me for many
years, that was my own precious mother from my
birth for many years, that took faithful care of me
for many years, called me sometimes Libbie, and I
think my name is Elizabeth. My own dear father,
who was kind and faithful to me for many years,
sometimes called me Libbie. I think I do not promise
to stay in this room. I don't think it necessary for
me to marry any man. A woman told me I must
not marry any man."

Senile Dementia. — Senile dementia is the result of

178 MENTAL DISEASES

both old age and of acquired cerebral disease. It
should be carefully distinguished from simple old age
or dotage. In the latter case the mind is weakened,
but the patient is clearly conscious of his own w^eak-
ness. He forgets a name or a date, and gropes
about in his memory to find it. The dement is not
conscious of loss of memory, but applies wrong
names to persons, and serenely thinks he is right.
Senile dementia is something more than the mere
loss of mental power which results from the natural
decay of the faculties. It is complicated also with
those pathological changes which are essential to the
production of insanity. It does not consist alone in
the enfeeblement of the faculties, because if it did we
would find that every old man is a victim of senile
dementia. There are several stages or degrees of it.
In the first occurs a loss of memory, particularly of
recent events, without any serious impairment of the
reasoning faculties. Early impressions and ideas
long retained now come up fresh from their rest-
ing place. From forgetfiilness of recent events,
accompanied by recollections of early ones, occur
many of those gaps in ideas and incoherence that, in
part, constitute dementia. This defect, or loss of
memory, generally marks the commencement of de-
mentia from this cause, but not invariably. Some-
times it begins with nervous erethism, accompa-
nied by the excitement of some faculty, fimction, or
active power, which may act with great energy.
Some become irritated by the slightest circumstance ;
others experience venereal desires long since extin-
guished; while others still, of regular, temperate and
sober habits, all at once manifest an appetite for
highly seasoned dishes and intoxicating drinks.

AND THEIR TREATMENT, 179

These symptoms are soon succeeded by those of
absolute dementia.

The second degree is characterized by a loss of the
reasoning power. Either the reflective faculties are
so completely impaired that they are unable to exer-
cise their functions, or the other faculties are so com-
pletely prolapsed that normal functions are no
longer exercised. The emotional faculties are so
much enfeebled that the will does not possess suffi-
cient strength and energy to carry out any process
of reasoning. The premises are scarcely laid down
before they are forgotten. Hence the inability to
draw conclusions from them. The transaction of
any business which requires a sustained attention
becomes impossible. Any slight or irrelevant idea in
disturbing the attention draws the mind away from
what it was considering, and thus destroys all at-
tempts at continuous effort. Some individuals in
this stage recognize their friends, but seldom mani-
fest any signs of emotion on seeing them.

The next stage, or third degree, is termed ** incom-
prehension," and is attended by an inability to com-
prehend the meaning of any principle or proposi-
tion, however simple, that is proposed. Attention,
memory, reason, all but the mere instincts, are
entirely lost. Here is sometimes found a great degree
of physical activity, such as jumping, running, or
walking. Some talk unmeaning jargon; others
mutter half sentences or broken expressions; while
others are found sitting in silence, scarcely pronounc-
ing a syllable for weeks, months, or even years.

The fourth and last degree consists in a loss of in-
stinctive action. The mode of existence is merely
organic. There is neither desire nor aversion, hardly
a consciousness of life.

180 MENTAL DISEASES

One more point concerning dementia. You may
be called upon in the courts to give evidence as to
the testamentary capacity of a person suflfering with
dementia. To do this justly, you must be able to
distinguish between dotage (old age) and dementia.
In both cases there is weakness of the mental powers,
but the victim of old age is, as I have already said,
cognizant of that fact. The senile dement does not
realize his condition, and more than this, if any
mental power is left he cherishes delusions or false
beliefs on account of the imperfect or erroneous im-
pressions received by his disordered senses. A clear
statement of facts as you discover them by a
cautious examination, and by a careful diagnosis
between the mental weakness of age and the mental
obliquity of brain disease, may enable you to con-
serve the ends of justice.

Pathological States

The blood vessels of the bodies of acute dements^
and especially the capillaries and veins, are dilated,
and their walls relaxed. The circulation throughout
is languid and sluggish. The general condition of
the mind is that of relaxation and obftiscation.

The pathological state of the brain of chronic de-
ments maybe best described by the term ** cerebral
chilblains." There is atony and dilatation of the
veins of the pia mater; the arachnoid becomes thick-
ened and opaque ; while the dura mater is but little
changed. The general condition is too sluggish to
produce any marked pathological impression upon
the dura mater, which is a tough membrane. The
frontal and parietal lobes are water-logged upon the
surface, and wasted within. The gray matter is
paler than usual, and the brain substance is tumid.

AND THEIR TREATMENT, 181

spongy, and edematous. The stasis or clogging oi
the circulatory apparatus of the brain readily ac-
counts for the marked mental failure.

The pathological conditions induced by the exces-
sive use of alcohol are thickening of the membranes,
slow serous effusions, atrophy of the cerebral sub-
stance, with sclerosis or hardening of the tissue.

LECTURE VIII

GENERAL PARESIS

We invite your attention to-day to the last gen-
eral form or division of insanity — ^namely, General
Paresis. This formidable and fatal disease is a cos-
mopolitan type of all modem insanity, and repre-
sents to the fullest degree the eflfects of toil, worry,
and intemperance in every shade and form. It is a
deep-seated, far-reaching, intractable scourge which
fastens its fangs upon the matured brains of its vic-
tim, and it rarely, if ever, yields up its hold.

Early in the nineteenth century Esquirol made
note of the fact that a person suffering with insanity
complicated with paralysis was not likely to recover.
In 1822, Bayle made some successful observations of
the disease, and outlined its description. In 1826,
Calmeil, a French physician, first intelligently and
carefiiUy described the disease known as general
paresis. Not until 1843 did Dr. Luther B. Bell, of
the McLean Asylum, near Boston, discover it in this
country. He reported several cases of the disease,
all of which died. In 1847, Dr. Pliny Earle, at that
time of the Bloomingdale Asylum, gave to the pro-
fession a few more cases of the disease ; and about
the same time Dr. Brigham, of the State Hospital at
Utica, detected and described the so-called new
malady.

Much has been written upon this same subject
since its first discovery. Probably the fullest and
most notable work upon General Paralysis of the In-

MENTAL DISEASES AND TREA TMENT, 183

sane is by William Julius Mickle, M. D., M. R. C. P.,
London.

But while modern doctors have studied the dis-
ease very fully, and while they have w^ritten much
upon this subject, no one has more concisely de-
scribed the disorder and its inevitable termination
than Shakespeare. Nearly three centuries ago, this
great polychrest of thinkers and observers wrote,
concerning the then undiscovered paretic :

* * Things small as nothing, for request's sake only,
He makes important: possessed he is with greatness;
And speaks not to himself, but with a pride
That quarrels at self -breath: imagined worth
Holds in his blood such swoU'n and hot discourse.
That, 'twixt his mental and his active parts,
Kingdom 'd Achilles in commotion rages.
And batters 'gainst itself. What should I say ?
He is so plaguy proud, that the death-tokens of it
Cry — No recovery. ^^

Troilus and Cressida, Act 11^ Sc, 3

The synonyms of general paresis are: General
paralysis, general progressive paralysis, general pa-
ralysis of the insane, mania de grandeur^ and de-
mentia paralytica or paralytic dementia. The latter
term might more appropriately be applied either to
the last stage of this general disease, or to a condi-
tion of both mental and physical loss following apo-
plexy, embolism, or thrombosis.

Just here we wish to define the difference which we
conceive to exist between paresis and paralysis. The
latter term implies a loss of the powers of motion,
either complete or partial. Accompanying this loss,
there is frequently an impairment of sensation as
well. Paralysis is from the Greek, TrapXvw, ** I loosen.*'
Paresis is from the Greek, TrapirjfUy **I relax,'* and
means a relaxation of the nerves of motion. In its

184 MENTAL DISEASES

eflfects upon these nerves it diflfers in degree from pa-
ralysis. Through the influence of paresis the nerves
become less "taut" than natural, and the result is a
certain tremuldusness of the muscles controlling the
organs of speech, and a general inaccuracy in the
movements of the arms and legs. The nerves re-
spond to every impulse for action, but in a lax and
hesitating manner, just as the strings of a violin give
forth imperfect sounds when they are but partially
tightened. In paralysis there is no response to im-
pulses of the will in the afilected parts. Some one or
all of the strings in the human violin are completely
unstrung or broken.

Stages

General paresis may be divided into four stages,
namely :

1. The incipient or irritable stage; the stage of
worry, anxiety, sleeplessness, and melancholy.

2. The well-defined stage of the disease ; the stage
of maniacal excitement, and of active delusions of
wealth, of power, and of grandeur, alternating in
some cases with attacks of temporary depression.

3. The stage of subsidence, w^hen the patient
passes into a condition of subacute or chronic
mania, with a general but slow tendency toward de-
cadence.

4. The stage of terminal dementia, of physical as
well as mental failure, and of death.

The first stage is usually marked by a long con-
tinued and suspicious prodrome. The man who has
been active and hopeful in appearance, yet withal
concealing an undercurrent of worry and anxiety,
becomes at last unable, through the effects of subtle

AND THEIR TREATMENT, 185

disease, to carry on concealment any longer. The
disease has robbed him of his natural carefulness.

The prospective victim of paresis worries more
than is his usual custom. Gradually his sleep is
shortened, and disturbed by anxious dreams. The
tendency to sleeplessness and anxiety may be accom-
panied by a sense of heaviness and fullness in the
brain, and this frequently extends to the degree of
positive pain, although some paretics assert that
they never had a headache. Still, the brain changes
which are observed after death would indicate that
the pains of slow, subacute inflammation have been
experienced.

From sleeplessness, melancholy, anxiety, and wor-
riment, the patient passes through the heaviness of
mental abstraction, until he suddenly loses self-con-
trol, and indulges in outbursts of anger. The de-
pressed and irritable stage is passed usually in a few
w^eeks or months, although this condition may last
two or three years before the upheaval of maniacal
excitement. In some cases the physical symptoms of
paresis are present, and the patient passes from a
condition of melancholy to a state of dementia with-
out being called upon to endure the excitement oc-
casioned by the cherishing of delusions of w^ealth and
grandeur.

Even in the melancholic stage it will be observed
that the paretic is more earnestly engaged in project-
ing enterprises than heretofore. In doing so he loses
his ordinary prudence in the affairs of life. He also
forgets the principle of right and wrong, and some-
times becomes a thief, because he thinks everything
he can lay hands on is his own property. The blunt-
ing of the perceptions of justice, and truth, and right,

13

186 MENTAL DISEASES

and honor is one of the first evidences of approach-
ing paresis.

Having passed through the stage of worry, anx-
iety, depression, and loss of the moral sense, the
patient finally develops full-grown delusions of
wealth, and power, and grandeur. At this stage
the natural affections of the man seem to fail. The
normal common sense having departed, the paretic
indulges in wild and extravagant purchases, or in
unwarrantable business schemes. He begins to feel
"first-rate," and yet he is evidently failing; and also
he becomes tremulous in body, and unsteady in
mental action.

The physician who is called to see an active
paretic in the early maniacal stage will probably
discover some of the following indications :

1. The pupils are either unequally dilated (one be-
ing larger than usual, while the other may be con-
tracted), or the pupils may be equally dilated, or
equally contracted. But in either case they are irre-
sponsive to light, that is, the motor muscles of the
pupil do not respond quickly and naturally to the
stimulus of light. Irresponsiveness to light," on the
part of the pupils, is characteristic of nearly every
case of general paresis.

2. The patient is unable to control the motions
of the eye. There is a certain restlessness and un-
steadiness in moving the eye which, to a careful ob-
server, is often discernible. Of course, people sujBFering
with chorea, or paralysis agitans, or some other
nerve disorder, may suffer with eye twitchings ; but
the history of their cases will eliminate them from a
consideration of paresis.

3. A dropping of one comer of the mouth is some-

AND THEIR TREATMENT, 187

times seen, owing to a partial paralysis of the facial
nerve.

4. There is a marked tremulonsness of the lips and
tongue. This tremulonsness of the paretic should be
diagnosed from that of acute drunkenness, or mental
excitement.

5. A slight hesitancy of speech is apparent, as well
as a deliberate attempt to overcome this inability to
articulate clearly.

6. There is a tendency to stammering, especially
when using words in which the letters i, /, xn, r, and
e occur.

7. There is a slight unsteadiness of gait, that is,
the patient has a shambling uncertain step as if the
knees were tired, and the owner could not determine
which way to bend them.

8. There is a smoothing out or a partial oblitera-
tion of the natural lines of intelligence in the face.

9. The skin presents a sallow and wax-like ap-
pearance, and sometimes feels as if it were greasy.
Greasiness and fiabbiness are characteristic of the
skin conditions of the paretic.

10. A slight exaltation of temperature. The tem-
perature of a paretic often runs from one-half to two
degrees above the normal, and during a convulsive
seizure, to which he becomes liable, the temperature
may go much higher.

These are some of the physical signs of paresis
in the active stage. Mentally, there is an intense
disturbance of the imagination. Visions of bound-
less wealth are conjured up in the overwrought
mind of the patient. A sense of power, the most
magnificent, pervades his every thought. He him-
self is the greatest and strongest man and finan-
cier in the world. (Women paretics have delusions

188 MENTAL DISEASES

about gold and diamonds, rich clothing, numerous
children, fine houses, and grand carriages. Women
paretics do not often attempt to make money. They
simply endeavor to spend what has already been
made). The expansive delusions are contrary to the
natural belief of the patient. Generally the victims
of paresis are plain, hard-working, common sense in-
dividuals, although they may be mercurial and ardent
in temperament, and ambitious to get on in the
world.

Under the influence of his mighty projects, the
paretic loses the power of considering the common
affairs of life. He forgets familiar names. He fails
to remember recent dates of appointments. He also
loses the power of calculating. His delusions multi-
ply and reduplicate fortunes in geometrical order,
while the forces of the mind, as applied to common
things, diminish in arithmetical ratio. Some paretics
make little account of immense fortunes, but they
fancy themselves the possessors of numberless wives,
or they see themselves pursued by countless enemies,
or they think themselves able to drink innumerable
flagons of wine. But whether the current of thought
is toward strong drink, or seductive sirens, or Crce-
sus-like wealth, it is a current that is forever widen-
ing and deepening until its unfortunate burden is cast
into eternity.

Sometimes, at irregular intervals, between his fit-
ful visions of unearthly grandeur, the paretic patient
sinks into the gloomy abyss of melancholy. There
are days when he weeps easily, and sends up a wail
of anxiety and hopelessness which contrasts with his
customary lofty and exuberant spirits as the moum-
fttl strains of the Dead March in Saul contrast with

AND THEIR TREATMENT, 189

the sublimer sweeps and surges of the Hallelujah
Chorus.

As the active paretic indulges in delusions of
strength and wealth, so he is likely to use the ordi-
nary courses of business transactions with which to
develop not only his special projects, but also to re-
veal his mental condition. The paretic patient will
often write scores of letters or telegrams in a single
day. He is always in an intolerable hurry to accom-
plish his w^ork; therefore he seeks to use the tele-
graph and the fast mail for the purpose of accom-
phshing his ends. It is an interesting fact that the
more excitable an insane person becomes, the larger
and more irregular are the letters which he makes.
In addition to making the letters large, the patient
in writing often omits words, or letters from words.
This may occur from inattention, and from the hurry
to get through the task. Occasionally the patient will
adorn his rhetoric by gaudy illustrations with col-
ored pencils. When the excitement subsides, and the
patient becomes quiet and calm, he will often resume,
to a certain extent, his natural style of writing; that
is, the letters will be formed upon a more moderate
plan, but the words or parts of words may still be
omitted. The paretic uses so much force and ink in
the construction of his letters, and is so anxious to
finish them, that they are often marred and blotted.

From the state of active delusion and active exer-
tion, the patient passes slowly and surely into what
may be termed the chronic state of paresis, w^hich is
marked by an exaggeration of all physical weak-
nesses, and a subsidence of the delusions, with occa-
sional flashes of excitement or attacks of depression.
The unsteadiness of gait becomes more pronounced ;
the tremtdousness of lips and tongue is strikingly

190 MENTAL DISEASES

apparent ; the patient is careless of dress and person,
and in every way we note a decadence of physical
and mental powers. Sometimes the appetite in this
stage is enormous, and the patient takes on loads of
fat. This soon passes away, and leaves the patient
thinner than ever. The march of the disease may be
interrupted by an episode of epileptiform convul-
sions, at which time partial paralysis may occur.
These attacks are often brief, the paralysis lasting
only a few hours or days.

After an attack of these convulsions, the patient
loses ground rapidly. The mind fails, and dementia
supervenes. The appetite is capricious, the physical
strength wanes, the body emaciates, and the nerves
atrophy. The skin, which has been flabby, sticky,
and clammy, is now apt to break out in eruptions
known as pemphigus foliaceus. At first these large
watery blebs are noticed on the extremities; after-
ward there is superficial ulceration of the derma,
followed by scabbing and attempts at healing.
These sores heal slowly, if at all. It is one of the
most remarkable features of this strange disease
that the patient may continue to live long after all
the forces of life appear to be exhausted, and when
little remains but the skeleton, overlaid by a parch-
ment-like and very ragged skin. Of course we are
now describing an extreme case, though many of this
kind have come under our observation and care dur-
ing the past twenty-five years. Relief from life comes
at last through utter exhaustion. Sometimes for
several hours previous to dissolution, the patient
becomes unconscious and thus passes away. With
others, consciousness remains until very near the
end, and with the last articulate breath of conscious
life the dying man, corrugating his countenance into

AND THEIR TREATMENT, 191

a ghastly smile, will reply to your inquiries as to
how he feels to-day with the stock expression, **fuss
rate.''

The pulse of paretics is soft and weak. This is
due to the relaxation of the muscular coats of the
arteries, and probably relaxation of the heart itself.
Every portion of the paretic's body is, to a greater
or less extent, relaxed and unable to perform normal
duty. The stomach and bowels partake of the gen-
eral relaxation, and the food is often passed undi-
gested. Lack of assimilation of food accounts for
the gradually increasing weakness and exhaustion
which this disease produces.

There is sometimes danger to paretic patients in
the act of eating, for they cram their mouths so full
of food at times as to almost suffocate. The muscles
of deglutition, also, being relaxed and eccentric or un-
certain in action, will sometimes suddenly fail, and a
patient will choke to death by the impaction of food
in the larynx. When a patient is inclined to eat
voraciously and rapidly, he should be fed carefiiUy
by an attendant, and his food should be of a liquid
or semi-liquid nature.

The paretic patient will sometimes grind his teeth
by the hour or by the day, and this is thought to be
a diagnostic symptom by some. But cases of acute
delirious mania will often grind their teeth, and so
will some cases of chronic dementia.

That you may see how naturally the actual facts
in given cases coincide with the pen picture which we
have presented, we will now give a few condensed
extracts from the records of the hospital under my
charge. The histories which we shall reveal will
bring you face to face with grim and sad realities.

P. B., act. 50, married. Symptoms of mental de-

192 MENTAL DISEASES

rangement had been well marked for nine months
previous to admission. For many years Mr. B. had
been engaged in business requiring a severe mental
strain. He was a man of excellent and methodical
habits, and strictly temperate, save in matters of
overwork and worry. Previously to the attack of
paresis his health had been good. In temperament,
he was of the nervous order. In disposition, he was
hasty and impulsive, although kind, and from prin-
ciple, carefully self-controlled. Three years before ad-
mission to the hospital, however, it was noticed that
he became unusually overbearing in his manner, and
for one year prior to admission was subject to noc-
turnal excitement. During the previous summer he
was attacked with melancholy, which was followed
by a maniacal outburst.

When admitted, Mr. B. was in good bodily health,
although he was not sleeping well. The only thing
he complained of was a necessity for passing his
water somewhat too frequently. He was very rest-
less, and spent his time walking up and down the
hall, talking to himself, and taking no notice of any
one. He claimed that his wife had been unfaithful to
him; and he also entertained the delusion that the
attic of the hospital building was stored with chests
of gold belonging to him. He worried and talked so
much about this, that he was finally taken to the
attic and allowed to examine it, and was greatly
disappointed at not finding any trace of the treasure.
Ordinarily he complained of no pain, and considered
himself perfectly well. For sometime this patient
continued his active exercise during the day, and
slept but little at night. After a time, when appear-
ing quite well, he admitted that his only brain
trouble was **forgetfiilness.'* Most of the time, how-

AND THEIR TREATMENT. 193

ever, he cherished and manifested delusions concern-
ing persons and events. At one time he indulged in
great railroad schemes, and was going to build an ele-
vated twelve-track road between all the large cities in
this country. This road was to be placed upon tres tie
work two hundred feet in height. Again, he had the
delusion, which he disclosed every day for several
weeks, that there were nine hundred, or more, head-
less bodies in the basement of the building in which
he was located. Again, he expressed very seriously
a wish to exchange heads with some one. And
again, he projected the idea of starting an immense
printing office w^hich would contain five hundred
mammoth Hoe presses, with which he would do all
the printing in New York City. While engaged in
these mighty projects, with the idea constantly in
mind that he could accomplish each one of these
chimerical enterprises, his memory was rapidly fail-
ing. He became so weak in this respect that he could
not remember even the names of his constant attend-
ants. He would ask the same questions over and
over many times in the course of a few minutes. At
length he came to have hallucinations of hearing,
and would frequently talk to imaginary persons.
Physically, he varied; at times eating ravenously,
and taking on much flabby flesh ; at other times fail-
ing in appetite, and correspondingly losing in weight.
It was noticed that he went often to urinate, and
that he drank large quantities of water. He was
watched on account of these peculiarities, and it was
observed that during ten hours he urinated eleven
times, and drank copious draughts from the water
tank seventeen times, besides drinking much at
meals. It was estimated that he sometimes drank
between three and four gallons of water in a single

194 MENTAL DISEASES

day. At such times he would consume with his food
large quantities of salt, pepper, and vinegar. His
friends, failing to secure from us any favorable prog-
nosis, determined to try a change of treatment. He
was taken to a water cure for a few days, and then
transferred to the care of a distinguished old school
physician in Connecticut who declared, so we were
told by the friends, "that the case was not by any
means incurable." He continued, however, to run
down, and died about a year and a half later.

In this case you will observe that the cause was
neither intemperance nor sexual excess, but simply
mental strain from business cares and worry. Also
there may possibly have been some hereditary taint,
which we believe to be unusual in such cases. The
father and mother, brothers and sisters, were always
mentally sound, but a maternal aunt was reported as
insane. The delusions in this case were marked, and
sleeplessness was a symptom, though many paretics
sleep well. The patient drank large quantities of
water without having any marked fever, a symptom
w^hich we have observed in quite a number of cases.
In no other non-febrile disease is there likely to be
such ravenous thirst as in paresis.

J. A., aet. 41, married, but had no children. The
disease had been gradually making its appearance
for about six months. The assigned cause was in-
temperance or fast living. Our prognosis was un-
favorable from the outset. The friends gave as the
history of the case that the patient had been ** irri-
table and strange-acting" for about six months;
that he had been a hard drinker for a long time, and
very ardent in the performance of marital duties.
During the two weeks previous to admission he had
been reckless, violent and unmanageable. This ex-

AND THEIR TREATMENT, 195

citement continued, and in fact increased after his ad-
mission. He indulged in many violent acts while
under the influence of delusions. Physically, he was
running down rapidly, so that it became necessary
to restrict his tendency to overexercise. At this
time he claimed that he was "king of gods ;" that he
made all the people of the earth, and that he could
raise all who had been dead over fifty years. He
claimed that he owned the whole world; that his
clothes were covered with diamonds. He wrote and
sent off* continually telegraphic messages to imagin-
ary persons. He declared that Queen Victoria, the
Empress Elizabeth, and the ** queen of poets" be-
longed to him as wives, and that he made them. The
patient was very forgetful of common and ordinary
names. During the second night of his stay with us
the patient thought that he made a trip to Heaven,
and gave to one of his friends there one hundred bil-
lions of dollars. In the morning he wanted two
hundred and fifty millions of gold with which to line
his room. He afterward thought that this wish had
been complied with, He slept very little for several
nights, but after a time greatly improved in this re-
spect. Physically, the patient was very weak and
scarcely able to walk, though he imagined that his
strength was limitless. His pulse for sometime
ranged from 64 to 100. When the pulse was low he
seemed much prostrated and enfeebled ; when it was
high he became w^ild and incoherent. The pupils
varied, the left being generally more dilated than the
right. When the left was normal, the right would
become contracted. The patient's speech was thick
and his words could scarcely be distinguished, yet his
delusions were utterly marvelous. At times he would
create several worlds in a single night. Again, he

196 MENTAL DISEASES

would be the possessor of numerous wives and
children.

About one month after admission the patient's
ideas of wealth passed away. He said that they
were only visions, and that he again felt poor. For
about two months he gained gradually, both in
mind and body. He gave up his delusions and talked
rationally, and the only apparent abnormal symp-
tom was a slight tremulousness of lips and tongue
when speaking. The patient was discharged at the
request of his friends. Although, to the untrained
observer, he appeared quite well, the result of his
case was entered upon our books as ** improved,"
and his relatives, when pressing us for an opinion as
to his future, were assured that he would, in all prob-
ability, suffer a relapse within six months, and that
he would never fiiUy recover. The sequel proved
that our prognosis was correct, for about five
months from the date of his discharge the patient
was readmitted. It was stated that he had been
quiet most of the time during his absence from the
hospital, and had attended meetings and gatherings
for amusement, but had worked at his business
scarcely at all. His friends said that he had gener-
ally appeared well, but not always "exactly right."
The night before he was returned he became violent^
and attempted to kill his wife with a hatchet. He
had delusions that enemies were after him, and that
he must fight them. He had no apparent ideas of
grandeur, and had cherished none during his vaca-
tion. A month later the patient had several slight
temporary attacks of left-sided paralysis, after which
he gradually failed in memory until he did not know
his own room. Then he became very wealthy again^
and thought that he owned the hospital, and was

AND THEIR TREATMENT, 197

planning to stock it ^th millions of dollars worth
of goods. He claimed that he had seventy immense
and costly stores filled with innumerable goods in
New York City. While cherishing these delusions he
seemed for a time to improve physically. After a
while blisters and sores appeared upon his hands,
and then he became less excited and more moderate
in his ideas. The ulcers on his hands finally healed,
and the patient appeared better mentally, having
given up his delusions of wealth. Under ophthalmo-
scopic examination, atrophy of both discs was re-
vealed. A month later he suffered another attack of
temporary paralysis of the left side, and his delusions
of wealth revived. He began to steal all the books
he could find, and locked them up in his bureau. He
was also caught masturbating, although he had
heretofore manifested no tendency in that direction.
He continued in this condition for about two
months, and then gave up his delusions of wealth,
and was again depressed. His appetite failed, and he
subsisted mainly upon milk and beef tea. Finally,
the sphincters became relaxed, and he frequently -wet
the bed. Two months later he had epileptiform
seizures, but rallied from them. He was greatly
emaciated, weighing only eighty-two pounds, and
yet for a time he appeared once more to be gaining.
His appetite improved, and his spirits were remark-
ably exuberant for an almost dead man. The week
following he had another epileptiform seizure ; it was
one of general and severe convulsion. The next day
he rallied and could talk, and still he manifested
delusions of wealth. He gradually lost in flesh until
he weighed but seventy-three and a half pounds. His
urine was retained, and it was drawn with a
catheter. The patient was unable to swallow, and

198 MENTAL DISEASES

-was fed regularly with a soft rubber nasal tube. A
month later the patient passed into a comatose con-
dition from which he rallied, recognized those about
him, spoke pleasantly, and assured us that he felt
" fuss-rate.'* A few hours later he quietly died.

A post mortem examination was made, and the
scalp was found to be very thin, as was also the
skull. On removing the skull-cap, three ounces of
serum escaped from the subdural space. The sub-
arachnoid spaces were likewise found to be filled
with serum. The arachnoid membrane was decid-
edly opaque. The pia mater was adherent to the
cortical substance of the brain, the result of long
continued inflammation. The brain weighed forty-
three and three-fourths ounces.

This case presents the most salient points of pa-
resis. The age, forty-one, the very prime of life ; the
condition, married, but having no children, conse-
quently no bar or interruption to sexual excess ; the
apparent cause, intemperance, and the final result,
death after such marked improvement as to insure
the patient's discharge for several months from the
hospital ; and through a period of nearly two years
the persistent abnormality of articulation, and the
condition of the pupils, together with the rise and
fall of delusions of grandeur and wealth, all these
form an imposing array of important and interest-
ing facts.

Mrs. F. E. E., aet. 31. The causes of insanity were
put down as ** grief and physical debility.'' At the
time of admission this patient was weak and un-
steady on her feet. There was slight tremor of the
tongue, and on extending the arms and hands, the
fingers trembled and twitched constantly. She had
a "happy-go-lucky" disposition at times, and again

AND THEIR TREATMENT, 199

was depressed. She rambled from one subject to
another, and took but little interest in her surround-
ings. Her temperature fluctuated between 99° and
101° F. She had a good appetite, slept well, and ap-
peared perfectly contented, always answering that
she felt "first rate" when questioned as to her feel-
ings. Two months from the date of admission the
husband removed the patient to her home, but was
obliged to return her to the institution seven months
later. She was then debilitated, filthy, demented,
and inclined to be violent when annoyed. She pre-
sented no symptoms of delusions or hallucinations.
On using her arms and legs, she exhibited consider-
able unsteadiness and loss of power. The tongue
was very tremulous, and she experienced much
trouble in pronouncing certain words. The intellect
gradually became weaker and weaker; she omitted
words when speaking, and often repeated others
several times. She crammed her mouth in an imbe-
cile manner when eating, and had to be watched
carefully, to prevent choking. The patient gradually
became more helpless and demented, dazed and
feeble. There was sordes on the teeth, the tongue
was red, and pointed to the left side. The skin
bruised easily, and was cold and dry, flaking off
easily. Later the patient was unable to swallow
solid food. The body became covered with red
spots, and the temperature rose to 102.2° F. The
eruption disappeared quickly, and the temperature
fell to normal. At this time the patient was in a
condition of absolute dementia, with muscular
atrophy throughout the entire body ; and legs, arms
and hands were contracted. About two weeks later
she passed away.

200 . MENTAL DISEASES

Here was a case demented almost from the very
first, and at no time presenting any delusions of
grandeur, wealth or position ; and although the pa-
tient was practically bedridden from the inception of
the disease, she lived over four years.

Causes

We come now to consider some of the causes of
general paresis.

A nervo-sanguine temperament, great physical ac-
tivity, vaulting ambition, imperfect education (many
men go into fields of great enterprises with very lim-
ited education, and with only half-trained brains), a
desire to attain and enjoy all good things in life,
coupled with anxiety and worry — that is, fear lest
the object in view may not be gained, or if gained,
may be unsatisfactory — these are the substrata of
conditions upon which the superstructure of general
paresis almost always rests.

The paretic is an adventurer, an explorer, a dis-
coverer of new means for the acquirement of wealth,
a diviner with a magic wand of imagination that
conjures up golden Golcondas in every business
scheme. Some of the most brilliant toilers and work-
ers for the growth of this new land have finally suc-
cumbed to paresis. Some of the brainiest of actors,
and wittiest of writers, and most zealous of poli-
ticians, and skilfiil managers of great railroad sys-
tems, have yielded to this dire disease ; and the cause
lies in a hyperstimulation of the brain and nervous
system by such means as hard work, coupled with
hard drinking, excessive sexual indulgence, and an all-
absorbing worry about every undertaking, whether
it be in the world of business or in the field of
pleasure.

AND THEIR TREATMENT. 201

Clouston says that "the things that most excite
and at the same time most exhaust the highest brain
energy are those which tend most strongly to cause
the disease ; to wit, over and promiscuous sexual in-
dulgence combined with hard muscular labor, a stim-
ulating diet of highly-fed flesh meat, the being all the
while excited and poisoned by alcohol and syphilis ;
all these things begun early in life and kept up stead-
ily." He declares that in Scotland **the Durham
miner when earning good wages fulfils the most per-
fect conditions for the production of general paraly-
sis. Every sixth lunatic admitted to the Durham
County Asylum is a general paralytic.'* Clouston
also states that ** the Asiatic is not subject to paresis,
that the savage is free from it, and that the Irishman
and Scotch Highlander must go to the big towns or
to America to have the distinction of being able to
acquire it." There are comparatively few cases of
general paresis where the causes may not be traced
to overwork in the field of worry, wine and women.
Some European authors have claimed that every
case of paresis is tainted with syphilis. While it is
true that paretics are likely to be exposed to syphi-
litic infection, it is not, we believe, either the universal
cause or the invariable accompaniment of paresis.
We can hardly accept the dictum of the Austrian pro-
fessor of syphilitic diseases. After listening to a lec-
ture in Vienna, I asked the professor if he had noticed
the affect of syphilis in the production of insanity.
He replied that he had not considered the matter, and
could not give the desired information, but closed his
remarks smilingly by saying: ** You know. Doctor,
that the whole civilized world is sypbilized P^ We
will admit that a considerable portion of the victims

of paresis have the syphilitic taint, but there are some
14

202 MENTAL DISEASES

paretic patients whose sexual habits have been cor-
rect so far as could be ascertained, and who have suf-
fered only with worry and anxiety about business
affairs. Such cases have overtaxed their physical and
mental powers, and produced inflammatory condi-
tions of the brain ; but they have neither tarried too
long at the wine cup, nor indulged in promiscuous
salacity.

Imperfect education, a bounding ambition, and a
feeling that one's strength will never give out may
rank as predispositions to paresis. A young man
with hopefal disposition, and strong, full-blooded
physique, will work and play with such a lack of
judgment as to land him at last in the bottomless
pit of paresis. Full of hope and health, he does not
realize the fact that there is a possibility of breaking
dow^n when he works like a slave all day, and enjoys
festivities like a Satyr and an Epicure all night.

In considering the causation of paresis, we note
the influence of sex, and find that at the Middletown
State Homeopathic Hospital there have been thus
far under treatment two hundred and fifty male
paretics and thirty-one female paretics. Possibly
men work harder and worry more than women, and
they may be less elastic than those of the opposite
sex in meeting and braving the ordinary vicissitudes
of life.

Paretics are more numerous in cities and in sea-
port towns than in the country. It is also a notable
fact that most paretics are very fond of rich meats,
and of strong coffee. A vegetarian mode of living
would probably save many from this disease.

Paresis develops usually between the ages of
twenty-five and fifty years. Dr. Clouston tells of a
case which developed at the age of sixteen, and Dr.

AND THEIR TREATMENT, 203

Guislain reports one at the age of seventeen. Occa-
sionally this disease may develop in old age, but the
insanity of that period of life usually takes on the
form of senile dementia, with its many-colored va-
garies, instead of paresis.

Pathology

The inflammations of paresis seem to involve in a
general way those portions of the cerebral mem-
branes which cover the frontal and parietal lobes.
Dr. Clouston has stated that when the mental symp-
toms are most severe the inflammatory processes
will be found located on the anterior and upper con-
volutions of the brain. If convulsive tendencies are
present, then these inflammatory patches will be
found at the base of the brain, and in the region of
the fourth ventricle. Also, Broca's convolution is
much involved when the speech has been especially
affected. The meninges in paresis are usually in-
flamed and thickened, and the pia mater, — that is,
the inner membrane — ^is adherent in small pin point
spots to the brain cortex. Under the influence of in-
flammation and the thickening of the membranes,
the brain mass itself becomes compressed, and we
have a condition, of atrophy of the nerve cells during
the latter stage of the disease. It has seemed to me,
also, that there has occurred in many cases an hyper-
trophic metamorphosis of the neuroglia. In other
words, the mass of cellular connective tissue which
keeps in place the nerve cells and the nerve fibres in
the cerebrum has become thickened. When this oc-
curs, there is pressure not only from above down-
ward, but from below upward, and from within
outw^ard, thus placing the nerve cells and the nerve
wires of communication from the brain to the va-

204 MENTAL DISEASED

rious parts of the body between what maybe termed
upper and nether pathological millstones. Some-
times the disease appears to start in the spinal cord
and work upward to the brain, and sometimes the
disease begins at the top of the brain and works
down into the cord.

The pia mater when peeled from the paretic brain
takes with it small, fine portions of the cerebral sub-
stance. The arachnoid membrane sometimes be-
comes opaque, and has small flaky deposits, together
with serous effusions. The dura mater is commonly
thickened and gorged with blood, and it presents a
loose, leathery, roughened appearance, which is a
strange contrast to the fine, smooth, closely woven
condition of the membrane in health. Occasionally
tumors of a gummatous nature are found in the
brain of paretics. Atrophy and sclerosis of the cere-
bral mass, and likewise of the great nerve tracks of
the body, are conditions generally found. The lungs
of the paretic are usually sound, but there is shallow
respiration. The heart becomes weak and uncertain
in its action; the kidneys are somewhat degenerated,
and symptoms of Bright's disease now and then
present themselves.

Diagnosis, Prognosis and Treatment

Paresis may be confounded with locomotor
ataxia, progressive muscular atrophy, and senile
dementia. While the muscular movements may
simulate those of ataxia and atrophy, you will
remember that mental aberration does not usually
accompany locomotor ataxia or muscular atrophy.
Senile dementia may be distinguished quite com-
monly from paresis by the age of the patient, and by
the absence of those very exalted delusions which

AND THEIR TREATMENT. 205

paresis engenders. From alcoholic dementia it may
be distinguished by the history of the case, and by
careful observation. The alcoholic dement is more
vague and uncertain and less persistent in his delu-
sions than the paretic. Of course if a drunkard and
a paretic are locked up in a hospital and kept under
observation for a sufficient length of time, the drunk-
ard will get well, while the paretic will continue on
his pathological toboggan slide to the end.

The prognosis is unfavorable, and usually the pa-
tient dies within from one to eight or ten years after
the inception of the disease. By means of rest in bed,
and a suitable diet, and proper care, the paretic may
live for several years. Whether the patient is in bed,
or up and dressed, he should be afforded an abund-
ance of fresh air and balmy sunshine. These blessings
should be brought to him ; he should not be obliged
to run after them. He should also be protected from
severe draughts of cold air, as the skin is apt to be
flabby and moist, with a sticky perspiration, and
consequently he may easily take cold. On the other
hand, he should be protected from the rays of a hot
sun, because excessive heat is extremely prostrating
and injurious to the average paretic patient.

Paretic patients should be secluded from every
care and toil. During remissions they may exercise
very gently, but they should be kept in bed when
they have reached the weak and tottering stage.
They should not be allowed to associate with other
excited patients, or run any risk of getting bruised or
tumbled about.

The beds for paretic patients should be soft,
elastic, and comfortable in every particular, to avoid,
so far as possible, the danger of bed-sores. The
patient's skin should be kept clean and firm by the

206 MENTAL DISEASES

use of alcohol baths, applied with a sponge, about
once in forty-eight hours; and wherever pressure
occurs the skin should be oiled once or twice a day
with cocoanut oil, gently but carefully rubbed in.
By a judicious use of oil, and alcohol and water, and
by the use of proper beds, and by skilful nursing,
the paretic patient will avoid, as far as possible, the
distressing annoyance of that hete noire of the hospi-
tal — namely, the bed-sore. If, in spite of every pre-
caution, a bed-sore should occur, then it may be
cleansed with Calendula tincture diluted with water,
three parts of the former to one hundred parts of the
latter. The ulcer may then be packed with Bichloride
of Mercury, one to five thousand. Should the pro-
cess of suppuration make deep inroads, then Peroxide
of Hydrogen will cleanse and help to heal all the by-
ways where pus is inclined to form and pocket. Vas-
eline with Calendula or Carbolic Acid maybe applied
as an emollient dressing, after the ulcer has been
thoroughly cleansed. A smooth bed and scrupulous
cleanliness are the main essentials in the treatment
of a bed-sore.

If you are called upon to select a climate for a
paretic, you should recommend Florida or Southern
California during the winter, and a slow, easy march
to the North when hot weather comes on. But if the
patient is unable to travel, then a moderate and uni-
form climate should be selected if possible. If you
cannot regulate the climate, then you should regu-
late the temperature of the room in which the pa-
tient is kept, and if you can maintain it at from 68
to 70 degrees Fahrenheit, you wiU do what is best
for your patient.

AND THEIR TREATMENT. 207

Prevention

The question now arises : What shall be done to
save men and women from the inception and inva-
sion of this fell scourge ? For fifty years the task of
curing general paresis has been attempted by faithful
and learned men, yet with only negative or unsuc-
cessfiil results. While we may record with pride a
series of triumphs against the ordinary foes of life,
we stand aghast before the inroads of this unyield-
ing vampire. Such being the fact, would it not be
wise to apply the means for prevention, rather than
engage in the discouraging task of patching up or
seeking to save the shattered fragments of an inevi-
table wreck ? The causes of paresis have been pointed
out. Prominent among these figure worriments, and
intemperance of various kinds. To prevent the
growth and development of these subtle causes
among the young, the vigorous and the successful,
we must give to them a better education, a loftier
purpose to shun evil and to do right, a clearer knowl-
edge of what that right is, and a most invincible de-
termination to accomplish the greatest good in life
without shattering one's forces upon the rocks oi
dangerous and needless excess. When the people,
through advice and warning from their physicians,
are brought to know and to realize the fatality of
their own self-imposed diseases, they may then, per-
haps, be induced to refrain from those formidable dis-
sipations whose feet take hold on destruction, whose
bite is like that of an adder, and whose final resting
place is a hopeless chamber and a death-bed within
the walls of a hospital for the insane.

The cares and afflictions of ordinary life, the re-
verses of fortune, the depletions of disease, the hered-

208 MENTAL DISEASES

itary weaknesses which come down to us from our
ancestors, all bring to institutions for the insane
their quota of sufiFering victims ; but many who are
thus afflicted may be stimulated by the hope of
restoration, and may indeed get well and return in
due time to their homes, and to a life of usefulness.
But for him who progresses to paresis through the
by and devious ways of his own worriments, and
dissipations, and gorgings, and exhaustions, there
are no more cheering words than those engraved
upon the portals of Dante's Inferno :

** Who enters here, leaves hope behind."

Young gentlemen: We have led you over a long
and tedious pathway. The march has been dry and
dusty, yet you have borne the heat and burden of the
day with a patient fortitude. I trust that you have
come to realize the importance of learning something
about insanity. It is imperative that you, as pro-
gressive physicians, should know something of in-
sanity, because it is prevalent everywhere, among
all classes and grades of people — the mighty and the
lowly, the poor and the rich. Again, you should
know something about its modem treatment. It is
a difficult disease to treat and to cure, and yet some
recoveries are attained by a practical application of
the Hospital Idea.

As we study and investigate this question aright,
we are forced to the conclusion that insanity is an
almost universal disease. It has, indeed, been a
most dreaded scourge throughout the ages. As we
examine the pages of history, we find that this terri-
ble disorder has stalked through the high places of
the palaces of the old Roman Csesars. It has swept
down like a Black Death upon the thrones of Spain,

AND THEIR TREATMENT, 209

of France, of Austria, and of Italy. It has buried its
cruel fangs in the brains of Bavarian and Belgian
monarchs. It has moved upon Russia with a force
greater than that which accompanied Napoleon
when he marched through snow and ice upon the
burning city of Moscow. It has sat at meat with
the mightiest rulers of Great Britain, converting
them into maniacs and dements, whose presence
upon the throne has formed the darkest blot upon
the pages of English history. And it has traversed
the mountains of the North, and infested that fair
and favored land which was once blest with the
rulership of a Gustavus Adolphus, and inspired by
the songs of a Jenny Lind.

Prince, peasant, and pauper alike have felt the
blighting touch of this withering witch who has
spread her death- wand over the civilized world for
many centuries, and whose ravishing activity is to-
day sapping the vitality and dissipating the mental
energy of the strongest nations on earth.

It is our duty to disclose the nature and the dan-
gers of insanity, and it is your duty to learn some-
thing about it, in order that you may be able to
assist in its prevention, and in its appropriate treat-
ment. No one-sided philosophy will explain its
nature, and no routine practice dispel her enchant-
ment. Only the earnest student who studies this
aberration of mind without fear and without prej-
udice will learn the secret of its enchantment, and so
dissolve the spell.

Who shall cure this dread disease ? Only the pa-
tient psychologist, the enthusiastic student, the
philosophical physician, and the earnest and zealous
philanthropist. The task is a mighty one, and in its
accomplishment one needs the courage of the soldier,

210 MENTAL DISEASES AND TREATMENT.

the zeal of the preacher, and the heroism of him who
would rescue from midnight flames the helpless vic-
tim of a conflagration. He who engages in this
work of leading the insane back to health, and who
spares no measure of brain or blood in the act, is a
person who is deserving of that glorious epitaph of
Lamartine's: "Workman in the cause of humanity."

LECTURE IX

TREATMENT

We now approach the last, yet most important
division of our subject, — namely, the Treatment of
the Insane.

When you are called to see a case of insanity, you
may be required to decide upon the disposition of the
case. That is, you may have to determine as to
whether the patient shall remain at home, or go to
a private sanitarium, or be committed to a State
hospital for the insane.

In all ages, the disease known as insanity has been
regarded as a disgrace, more or less, hence it has
been concealed from general observation both by the
patient and his friends. This concealment of mental
weakness or aberration is natural, because the
human being is so constructed that he almost al-
ways endeavors to hide his defects of both body and
mind. Therefore, when you are called to treat a case
of insanity, you should not hastily consign the vic-
tim to a public hospital, for by so doing you may
put a public stamp upon the entire subsequent life of
your patient. That a person has been insane should
not be regarded a disgrace, but simply a misfortune ;
yet the fact remains that when once his insanity is
known, the person is always afterward likely to be
regarded with suspicion and distrust by those
around him. That feeling will by and by, in the
coming enlightenment of the world, pass away, but

212 MENTAL DISEASES

until it does we must consider its efFect in the dispo-
sition of each case brought to our attention.

Home Treatment. — Some insane patients may be
cared for at home, although, as a general rule, the
disagreements with home life, experienced by the in-
sane man, are a bar to recovery. Home treatment
may, however, be attempted for the following class
of cases :

1. Those w^ho are w^ealthy, and who can afford
the luxury of every possible care. Such patients may
be put in charge of trained nurses and experienced
physicians, if the friends are willing to convert a por-
tion of the house into a hospital, and are willing
to refrain from interfering with the necessary care
and treatment. If the attending physician cannot
control and direct the treatment absolutely at home,
then he should suggest a change.

2. Quiet and harmless insane patients— that is,
cases of chronic melancholia where the delusions
have crystallized, and where the disposition to sui-
cide has subsided. Also, there are cases of chronic
dementia, or of imbecility, or of senile dementia, that
may be cared for in private homes or in cottages, if a
reasonable amount of patience and tact and watch-
fulness can be exercised in their behalf In treating
the insane, you should always consider, first, the
feasibility of home treatment.

Sanitariums. — ^When the interests of the patient,
or the highest interests of the friends demand that
the insane person should be removed from home,
then the next question to decide is : Where shall he
go ? If he is blest with the luxury of wealth, he may
be sent to a sanitarium, if a suitable one can be dis-
covered. Great care should be used in the selection
of a sanitarium. The welfare of the patient will

AND THEIR TREATMENT, 213

depend upon the nature and character of the man
in charge of such a place. If the spirit of avarice
holds sway, then it is likely that the patient will get
but small return for a large outlay. Private sani-
tariums should be careftdly inspected by public offi-
cials in such a way as to promote the interests of the
patients, and in such a manner as to accomplish fair
and just results between man and man. Sanitariums
have their advantages. By going to such a place the
insane man is enabled, oftentimes, to hide his disease,
and consequently his fancied disgrace, from his neigh-
bors. If he can go to a sanitarium and get well, he
returns to his home and the community where he
formerly lived, and immediately takes his old place
in good and regular standing. He has simply been
absent from home, to recuperate from nervous pros-
tration.

State Hospitals, — When the resources of the home
and of the sanitarium have failed, or when the finan-
cial ability of the patient can no longer meet the
strain of either home or sanitarium care, then a
public hospital that is free to the poor, and moderate
in its charges to those who have a little money left,
may be secured. To this end, the State hospitals
have been established.

When a patient is sent to a State hospital the
method should be straightforward and honest. If
able to comprehend anything, he should be frankly
told that he is sufiering from mental disturbance,
and that his friends propose taking him to an insti-
tution for treatment. He may object, but his scruples
may often be overcome by kindly reasoning. If that
is of no avail, then force, rather than deception,
should be resorted to. Everything pertaining to his

214 MENTAL DISEASES

4

removal should be conducted in a prompt and
orderly manner after a preconceived plan.

Treatment

The means which we have employed at Middle-
town for treating the insane may be put down as
follows :

1. Kindness and gentle discipline.

2. Rest as a means for physical and mental recu-
peration.

3. Bathing and massage.

4. Enforced protection.

5. Artificial feeding.

6. Dietetics.

7. Exercise, amusement and occupation.

8. Moral hygiene.

9. Medicine.

Kindness and Gentle Discipline. — Formerly in-
sanity was considered as a visitation from the Devil,
a possession in every fibre by his Satanic Majesty,
and the treatment consisted of punishment — such
punishment as confinement in a dark cell for the
comfort of the soul, chains for the aching limbs,
stripes for the back, shower baths for the heated
blood, and for the drooping heart there were con-
jured up the inspiring influences of gaunt and ghastly
fear! But, to-day, the treatment of the insane is
based upon the broad and comprehensive principle
which is embodied and shadowed forth in the pre-
cepts of the Golden Rule. Kindness is the Blarney
Stone which every man, who would attempt the
work of treating disordered intellects, must kiss, and
thus imbibe its inspiration. To be sure, the insane
must be controlled and governed, but while the ad-
ministration of discipline is at times necessarily firm

AND THEIR TREATMENT. 215

and unjrielding, it should in every word and action
be tinctured with the essence of human benevolence.
The more irresponsible the patient, the gentler and
more sympathetic should be the treatment. As pa-
tients resume their normal condition, they may be
more and more subjected to the influence of laws nec-
essary for proper government. As loss of self-control
is a prominent indication of insanity, so a resump-
tion of self-restraint is a pleasant indication of ap-
proaching recovery.

Rest in Bed. — When a patient is admitted to the
hospital, he is at once carefully examined by one of
the medical officers of the institution, and if he seems
debilitated, eveii though manifesting much excite-
ment and insane strength, he is sent to one of the
hospital wards and placed in bed, where he may be
under the constant care of trained and skilled nurses.
For many years we have made constant repose in
comfortable beds a prime adjuvant in the treat-
ment and cure of insanity, and in prolonging the
lives and promoting the comfort of those who are
aged and feeble and unlikely to recover. We find
that the victims of every form of insanity, whether
that form be characterized by mental depression, or
mental exaltation, or mental enfeeblement, or mental
failure, are greatly benefited by bed treatment. The
victims of melancholia rise more surely from the
** slough of despond" when placed in bed, and prop-
erly nourished and protected from every adverse
exposure, than when they are allowed to sit up and
be dressed. The victims of mania become quiet and
tractable, and make better progress toward recovery
in bed than anywhere else. The victims of general
paresis are less liable to receive injuries, and their
paroxysms of tremulous excitement subside sooner

216 MENTAL DISEASES

when plaxred in bed than when they are dressed and
staggering about the ward. The victims of dementia
are less filthy, and can be better cared for and made
more comfortable in every way when in bed than
when up and dressed, and planted in chairs along
the corridors of hospital wards. Apathetic and de-
pressed patients are not only less filthy when sub-
jected to careful hospital treatment in bed than when
up and around the ward, but they also sleep more
during the twenty-four hours than they otherwise
would. They likewise take their food better, and
thus physically thrive more prosperously than when
out of bed. We have observed many cases where
patients on being taken from the bed and dressed
would refuse to eat their food, but when returned to
a recumbent position upon an easy mattress they
would immediately begin to take their customary
rations.

The advantages of this plan are :

1. The waning forces of the patients are most
surely conserved.

2. An easy circulation of the blood throughout
the entire system is facilitated, and thus the wastes
produced by disease are most speedily and naturally
repaired.

3. Digestion and assimilation of suitable food, in
cases where the normal functions of the body are
much below par, are best promoted in bed, providing
suitable care and treatment are administered.

4. The patients are more readily protected from
injuries when in bed than when dressed and allowed
to wander about the ward in association with dis-
turbed or violent patients.

5. The application of heat is most readily made,
and its benefits most uniformly secured when the

V

>

AND THEIR TREATMENT. 217

patients are in bed and careftilly covered with suit-
able clothing. The danger of exposing the extremi-
ties to chilling draughts is thus most surely averted.

6. Attendants treat bed patients with more tender
consideration than they usually bestow upon cases
that are dressed and about the ward. A sick person
when in bed always excites more kindly sympathy
and more attentive care than when he is attired in
his usual clothing, and moving about among his
fellows.

7. An insane person if weak in body, and either
excited or depressed or apathetic in mind, recovers
more rapidly and certainly when afforded proper
bed treatment than when allowed the freedom of
daily exercise. I believe that many of the insane
may be saved from the trackless realms of chronic
dementia if suitable rest treatment is afforded and
enforced during the stormy, or sullen, or obfiiscated
experiences of mania, or melancholia, or acute
dementia.

Rest in bed does not mean neglect by nurses. On
the contrary, it means increased care by specially
trained nurses. The patient must be carefully and
regularly looked after; his skin must be kept in
good condition; his mouth must be cleansed with
pure water at regular intervals ; the bowels, if con-
stipated, must be relieved by enemas of warm water;
the bladder must be emptied of its contents as often
as that organ becomes filled ; and baths of various
kinds must be given.

We use baths as follows :

1. The simple towel or sponge bath, where the pa-
tient's body is laved a little at a time with alcohol
and water — one part of alcohol to four or five parts

of water, — and then the part is rubbedjuntil dry.
15

. I

218 MENTAL DISEASES

2. The spray bath is used for those who are strong
enough to sit up. This bath not only cleanses the
skin, but stimulates by its fine and exhilarating force
the subcutaneous nerves throughout the system.

3. The old-fashioned tub bath is given to those
who desire it, using warm water at the outset, and
finishing with cold water and a brisk rubbing.

Bed patients also receive massage when neces-
sary ; and they are sometimes anointed, from head
to foot, every night with cocoanut oil, or olive oil.
We use. externally, when the patient seems very
much strained and exhausted, cocoanut oil, ninety-
five parts, and Hypericum tincture, five parts. Hy-
pericum is called, as you know, the "Arnica of the
nerves,** and this preparation is a most soothing and
agreeable one. If the patient has, upon admission,
recent bruises upon the body, we apply Arnica and
oil in the same way. Old bruises which are dark
from subcutaneous hemorrhages may be treated
with Hamamelis and oil.

Enforced Protection. — Many of the weak and ex-
hausted patients coming to us for treatment are
quite willing to rest in bed. They are already the
victims of overwork, and rest comes to them as a
boon which has been desired for years, but which
could not heretofore be attained. Others require to
be restrained to a certain extent. This restraint, or
care, or protection may be applied by a nurse who
will put the patient back to bed whenever he gets up,
and kindly encourage him to remain there ; or, if that
is insufficient, we use a body bandage. That is, a
band is placed around the waist and fastened at the
back with soft tapes. On either side of the body band-
age is a strip of cloth that is tied around the bed rail.
The restless, incoherent, and harmless patient is kept

AND THEIR TREATMENT, 219

quiet by this means, for he finds, after a Uttle, that
he cannot get up, and therefore stops trying to do so»
' Others are restless all over ; constantly moving the
legs, the arms, the body, and the head. In such cases
we apply what is known as the *' protection sheet,''
which is an addition to the body bandage, and
which covers the entire body, with the exception of
the head and neck. When this protection sheet is
carefully applied, the patient cannot get out of bed,
nor can he hurt himself in any way. If his knees are
chafed from motion, then he should wear drawers,
or a bandage may be applied, extending from the
ankle to the middle of the thigh. An ordinary surgi-
cal bandage applied as if to hold a splint in place
will answer the purpose.

Some patients are pugilistic, and inclined to hurt
others ; or they are suicidal, and inclined to mutilate
themselves. We protect such cases by the use of
padded mittens. Large canvas mittens are made
and padded with cotton, and inside the cotton we
place a smaller mitten to hold the hand. When these
mittens are properly used, the patient can do but
little damage to either himself or others. (The * ^pro-
tection sheef was first applied at the Middletown
State Hospital over eighteen years ago, and it has
been used here, as needed, ever since. It has also
been introduced into many of the progressive insti-
tutions of this country).

In your private practice, you may be called upon
suddenly to take care of a very violent and restless
case, and if you have no appliances at hand, you
may make a cocoon by taking three or four common
sheets, such as you will find in every house. Sew
these together, and roll them up like an ordinary
bandage, and then apply the bandage to the entire

220 MENTAL DIESASES

body, from the head down, just as you would band-
age an arm or a leg. You may pinion the arms to
the sides of the body, before applying the cocoon,
with long towels or strips of cloth. When a patient
is rolled up in this cocoon, and the end of the roll is
fastened with safety pins, you may put him in bed,
and he cannot get out, or move around at all. The
cocoon is simple and effective. If you are obliged
to apply the cocoon rather snugly, as in the case of a
fiercely excited patient, it is wise to put a few layers
of cotton over the chest, to relieve the inflexibility of
the bandage.

Exercise, Amusement and Occupation, — After the
newly admitted patients have been favored with
rest treatment for a sufficient length of time (and
that time may be one month, or three months, or six
months, or twelve months), then we prescribe exer-
cise, amusement, and occupation for them. At first
they are allowed to sit up in an easy chair; then
they are allowed to walk around the day-rooms;
then they are permitted to play on the piano, or play
cards, or dominoes, or billiards. A little later they
are allowed to exercise on the grounds. The exercise
is increased until the patients are suflficiently hard-
ened to engage in some useful occupation, such as
working on the wards, or in the dining-rooms, or in
the sewing-rooms, or folding clothes in the laundry,
or cultivating flowers in the greenhouse, or promot-
ing the growth of vegetables and grains in the gar-
den and on the farm. By such a course of treatment
we have had the pleasure of seeing apparently hope-
less cases, after long periods of rest and nourishment,
rise from sick beds and progress to genuine and sub-
stantial recoveries. After rest and care and nourish-
ment have effected both physical and mental recup-

AND THEIR TREATMENT, 221

eration, then the duties and burdens of life may be
gradually reassumed. But labor should be imposed
in very moderate doses, and the drug of toil should
be given in the attenuated form.

In the care and treatment of the insane great
caution should be exercised while the almost recov-
ered are completing the term of convalescence. As
the twilight and the dawn are the most dangerous
seasons for those of suicidal tendencies, so the last
days of convalescence, when the patient is feeling
once more the impulses of recovery, are oftentimes
critical periods which need special attention.

ArtiBcial Feeding, — Insanity is a symptom not
only of mental aberration, but likewise of physical
depletion and cerebral exhaustion. Especially is this
true with regard to the various forms, shades and
degrees of melancholia and mania. We find in those
suffering with mental depression, oftentimes a direct
lack of desire for food, while those laboring under a
stress of mental exaltation are quite apt to neglect
the inception of nourishment through inattention
rather than through anorexia.

The first essential in the dietetic treatment of the
unwilling insane for curative purposes is the en-
forced administration of sufficient quantities of food,
to prevent too rapid waste throughout the indi-
vidual system, and to promote recuperation from
losses already sustained ; and likewise to increase, if
possible, the capitalized resources of the human form
divine.

The second essential is the selection of such food
as will most rapidly and surely promote the rebuild-
ing of those portions of the human temple which
have been disgruntled or shattered by the effects of
disease.

222 MENTAL DISEASES

The third essential is the administration of the
selected food in such a manner as to avoid all un-
necessary shocks ; to promote, in fact, easy and rapid
digestion, and to favor the speedy assimilation of
digested food by the tissues of the body. In our ex-
perience we have found that forced feeding may most
readily be applied by the use of a soft rubber naso-
stomach tube. This tube, as now used, was the in-
vention of one of my former assistants, Dr. N.
Emmons Paine, and is a modification, both in con-
struction and use, of the soft rubber catheter of
Nflaton. When this tube has been inserted through
the nose, and passed on to the stomach, by a phy-
sician or skilled nurse, the food may be injected
through it in required quantities by means of an
ordinary rubber syringe.

Those who continue the administration of food |

through the old-fashioned stomach tube prefer, as a
rule, I believe, that the patient shall be in a sitting
posture when fed; but when using Dr. Paine's soft
rubber naso-stomach tube it seems preferable to
have the patient lying on his back. In this supine
position, the patient is less able to voluntarily re-
gurgitate his food than when he is allowed to sit up.
This is an important clinical fact, because many pa-
tients who need forced feeding are apt to acquire the
habit of regurgitating food when they are thus fed.
This they can do less easily when in a supine position
than when sitting upright.

Now in addition to the method of forced feeding,
to which we have referred, we may state that in feed-
ing indifferent and unwilling insane patients it is
always wise to begin by coaxing and persuading the
sick person in the gentlest and most tactful manner
to accept food voluntarily rather than to have it

AND THEIR TREATMENT, 223

forced into his stomach. Many a reluctant patient
will eat when properly and persistently coaxed by a
skilful and judicious nurse.

Dietetics. — We come now to a consideration of the
varieties of food best adapted to those depletions
and exhaustions which precede and accompany
mental and nervous diseases.

Owing to the restlessness and the exhaustion of
the insane, and to the fact that the life forces wane
rapidly, and the blood inclines to lose some of its
natural fluidity, it seems to me that the diet at the
outset should consist largely of hot liquid foods, and
principally of milk. The disrepute into which milk
has sometimes fallen as an article of diet for either
the sick or the well has arisen from the fact, to a
large extent, I believe, that it has been administered
cold instead of warm. Coming from the ice chest,
or sipped from a glass filled with lumps of impure
and death-dealing ice, and after being taken from
diseased cows, it has often been a dangerous diet
for even the most healthy. When milk is taken cold
in large quantities it chills the weak stomach of
the invalid ; it curdles and forms indigestible lumps ;
and it ferments and brews putrescent gases in the in-
testines. But when pure milk is brought to a blood
heat, or a higher temperature than blood, and then
administered to the worn and exhausted victim of
disease, it favors digestion and assimilation, and
prevents, to a very large extent, the evils of cold
milk to which we have referred. If you have any
doubt as to the purity of the milk you use, you
should have it sterilized. This can be done in any
house by putting the milk in a clean vessel, and
bringing it up to a heat of 160° F., and keeping it
there about twenty minutes. This process destroys

224 MENTAL DISEASES

the germs without seriously changing the quality of
the milk. You should always procure milk which
has been cleansed by the use of a separator.

In addition to milk, you may give beef tea, bean
broth, and chicken, clam, oyster, and other soups.
You may also give gruels made of oats, and barley,
and wheat, and rice, and com, and other cereals. You
may give soups containing much cream, and flavored
with such vegetables as celery, and lettuce, and
tomato, and beans or peas; and you will find the
various concentrated foods valuable aids to treat-
ment.

An exhausted invalid should take food in moder-
ate quantities, in order to avoid overtaxing the
powers of a weakened stomach, and after each inges-
tion of food the organs of digestion should be al-
lowed to do their work fiiUy, after which a brief
period of rest may be enjoyed. But this rest should
not be long continued, for if it is, then exhaustion
of the patient, through lack of proper and necessary
nutrition, speedily follows.

After many experiments, we have concluded that
a weak insane person should be fed once every three
hours, from 6 a.m. till 9 p.m.; and if the patient is
sleepless during the night, then the food may be con-
tinued every three hours throughout the entire day
and night.

Hot milk may, with almost absolute safety, form
the daily diet and the midnight hypnotic of the
mental invalid. Should such a food prove too rich
in some individual case, then the milk may be diluted
with Ume water, or with clysmic, or seltzer water.
Should the proportion of cream in milk seem too
large, then it may be reduced by skimming. Thus
the amount of fat to be administered to a given pa-

AND THEIR TREATMENT, 225

tient may be regulated, by experience to meet the
actual necessities of the case. You may also enrich
milk by the addition of cream when necessary for the
better nourishment of emaciated cases. The cream
diet may be improved by whipping up the white of
an ^^'g with about four times its bulk of cream.

Aged patients are often benefited by the use of
buttermilk. In fact, all patients who have easily dis-
ordered kidneys may be almost invariably benefited
by the use of firesh buttermilk.

If you have a patient who is very fat and flabby,
or who is suffering with dyspepsia, you may begin
the rest treatment with skimmed milk for two or
three weeks, in order to allow the useless debris to
pass away from the system.

While a hot liquid diet is being administered the
patient may, if he craves solid food, be treated two
or three times a day to a slice of toasted stale bread
of such variety as he may select — that is, either w^hite
bread, or graham bread, or rye bread.

After a patient has, by the use of a hot liquid diet,
fleshed somewhat beyond his normal weight, then he
may be allowed solid food, consisting largely of the
various native and imported grains, together with
vegetables and fruits, and a very moderate supply of
meat. Rich and stimulating red meat is sometimes
good for cases of melancholia, but cases of mania
and general paresis should be restricted as to the
eating of meat. It sometimes stimulates too much
those who are excitable and nervous. Meat should
also be withheld from those who are suffering with
epileptic insanity. During convalescence, patients
may take a good deal of fat-producing food with bene-
fit. It is better for the nervous and the excitable to
take, instead of much meat, plenty of butter, and

226 MENTAL DISEASES

salad oil, and cod-liver oil. It is always a good plan
to get the patient fat as quickly as possible, but
while undergoing the process, a sufficient amount
of mental stimulus must be applied to keep the brain
in moderately active working order while the bodily
recuperation is going on. Thus the danger of demen-
tia is averted to a considerable extent.

With the grain foods there may be given an
abundance of fresh butter and ripened cheese, or
both. Butter and cheese are simply the concentrated
products of milk, and they are therefore to be reck-
oned among the best articles of nutrition for the
human body.

Raw or rare cooked eggs go well with milk ; and
fat bacon or fat spring lamb, with baked potatoes,
form excellent additions to the dietary used for the
permanent recovery of the convalescent insane. Fruit
is allowable in abundant quantities during convales-
cence. It is said that the ancients when they felt the
approaches of old age went down into the gardens
of Hesperides and ate apples in large quantities, and
thus renewed their youth.

By such a primary and secondary, or combined
course of dietetics, the nervous systems of mental in-
valids are ** renewed like the eagle's"; and also by
the administration of a moderate daily exercise, in
conjunction with solid diet, the muscle tissues be-
come strong again, and ready for active use in the
customary walks of life.

Above all things the quality of the food given to
the insane should be of the best, and its preparation
for consumption should be made with the anxious
care of a mother, the delicate tact of a sister, and the
scientific skill of an accomplished chef. Those who
prepare food for the use of human beings should be

AND THEIR TREATMENT. 227

earnest students of psychological effects, as well as
adepts in the esthetics of cookery. The attainment
of desired results in the preparation and administra-
tion of food for and to both the sick and the well is a
lofty and growing ideal, and worthy of the careftd
study and the critical attention of every one who is
interested in the prolongation of human life, and in
the preservation and continuance of health. And the
food, after it has been prepared as attractively as
possible, should be served with dainty delicacy. The
refined air and the scrupulous neatness of a restau-
rant kept by a Delmonico should be assumed in the
wards of every hospital, even when only a glass of
milk is being served to an insane patient.

Every insane person should have at all times free
access to fresh water for drinking purposes. Some
persons who avoid fresh water while in their right
minds will drink plenty of it when they are insane,
and it seems to do them a great deal of good.

Stimulants are rarely needed for those suffering
with insanity. The brain is in a hypersensitive con-
dition in such cases, and cannot well endure the
added irritation which comes from the use of alco-
holic liquors. Yet there are cases of great debility,
where the stomach is too weak to retain and digest
food, where champagne in small doses may be admin-
istered with beneficial effects. Sometimes brandy or
whisky may be needed to stimulate the flagging en-
ergies of a weak and failing heart. But such a
resource is an infrequent necessity. When stimulants
are given, only the best and purest articles should
be employed.

Moral Hygiene, — Moral hygiene is just as essen-
tial in the treatment of insane persons as food is nec-
essary for the mitigation of hunger. Moral hygiene

228 MENTAL DISEASES

consists in transmitting soul encouragement from
the strong to the weak. Doctors and nurses should
seek by kind and soothing and stirring words to in-
spire new spiritual energy in the lives and motives of
their patients. Many a patient has been erratic and
undisciplined throughout his life, and it is this lack
of discipline which often brings a patient to a hos-
pital for the insane. The establishment of mild but
judicious direction on the part of those in charge of
such patients is a prominent portion of their duty.
Every faculty must be cultivated by means of moral
hygiene; every emotion must be restrained, and
every passion must be subdued, in order to enable
mental invalids to possess that perfect self-con-
trol which is the loftiest attribute of sanity and
strength. The gift of administering moral hygiene is
sometimes a natural one, but even natural gifts may
be cultivated and strengthened. Hence it is the duty
of the physician and the nurse to understand one's
self, to cultivate one's own powers, to be inspired by
noble purposes, so that the work of transmitting in-
spirations and disciplinary measures may be suc-
cessfiil. This is the aim of all modem schools of
psychology.

Operations

In the treatment of mental disorders, operations
have been made for the relief of epilepsy, and for the
relief of traumatic injuries. In some instances pres-
sure upon the brain may be relieved, but a cure does
not often follow an operation where epilepsy has
become firmly established.

It is thought by some that orificial surgery will
accomplish much for the insane. Operations for the
relief of disorders of the distal extremities of the

AND THEIR TREATMENT, 229

digestive apparatus have been performed in numer-
ous instances, and these operations it is said have re-
sulted in beneficial effects not only to the local physi-
cal disorders, but likewise to the general nervous sys-
tem. Our own experience in these matters has been
limited. We have relied not so much upon an opera-
tion as upon position, rest, and absolute cleanliness.
Rectal diseases are often much relieved by prolonged
rest in bed, thus relieving pressure upon all of the
pelvic organs. Hot water, both external and in-
ternal, aids in relieving chronic congestions and con-
stipations. The homeopathic remedy, appropriately
applied, will do its work most thoroughly and satis-
factorily, when the patient is in bed, and suitably
cared for by a trained nurse. We had one case where
the orificial operation was not successful, and
through disappointment the patient became a victim
of melancholy. This case was put to bed, and the
large ulcers around the remnants of his rectum were
successfully healed, and the patient regained his
normal mental status.

We have also had under our notice cases of in-
sanity in women who have had a part or all of the
reproductive organs removed by the surgeon. In
some instances it has seemed that the disease preced-
ing the operation has tended to mental disturbance,
while in other instances the insanity has followed the
operation as an apparent result of shock, hemor-
rhage, and radically changed physical conditions
within the human temple.

I believe that a careful discrimination should be
exercised by the surgeon in the performance of every
capital operation, and that the possibility of mental
disorder following a severe operation should be
weighed before the undertaking is consummated. It

230 MENTAL DISEASES

has been demonstrated that formidable operations
maybe performed without much loss of life, but if the
last state of a diseased victim is to be worse than the
first, as the result of a grave operation, then it seems
to me that the wiser course would be to refrain from
using the knife in such a case. It is possible for a
woman to live in comparative comfort, and with a
good deal of serenity of mind for many years even
when aflGlicted with organic disease of the reproduct-
ive system, by the adoption of appropriate hygienic
and dietetic measures, and by scientific medication.
The simple prolongation of life is not the highest aim
of the physician or surgeon, especially if it is accom-
panied with great mental distress. It is better to
have one year of peacefiil and contented and health-
fill mind, than it is to have five years of a new life
with an added burden of an agonizing soul torture.

In performing a serious operation, the surgeon
should not only consider the probability of extend-
ing the life of his victim, but also the probability of
casting his victim into the toils of protracted, and,
very likely, incurable insanity. Therefore, before
making any such operation the surgeon should not
only consider the physical strength of his patient,
and her ability to endure the process of carving, but
he should inquire into the mental antecedents and
tendencies of his case, and if mental disorder is likely
to supervene upon his work, he should refirain fi"om
operating, and seek those mild and less heroic meas-
ures for continuing life, and, above all, for preserving
mental peace and health of mind.

In concluding this lecture on treatment, we wish
to impress upon your mind the fact that the treat-
ment of the insane should always be in accordance
with the loftiest principles of the Hospital Idea,

AND THEIR TREATMENT, 231

which seeks to exemplify everything that can be in-
spired or suggested by the spirit of kindness or -sym-
pathy, and which seeks to embody in the line of
practical utility everything that can be acquired in
behalf of the sick by intelligent human thought or
action. The Hospital Idea embraces all that is known
in sanitary science as applied to the protection of
human life. It embraces all that is known of dietetics
as applied to the restoration of impaired physical
energy; and it embraces the education and train-
ing of nurses, whose nightly vigils are to supplement
the daily visits of the physician. The Hospital Idea
is the loftiest embodiment of that mighty and far-
reaching rule: **Do unto others as ye would that
they should do unto you." The Hospital Idea is a
topic as vast as ocean depths, as magnificent as
mountain peaks, as enduring as are the experiences
of sin and sorrow among men. Its application is the
last and grandest work of the philanthropist and a
sure forerunner of the millennial dawn. The treat-
ment of mental invalids is being more and more
idealized from year to year, and the best methods of
the general hospital are steadily coming into vogue
in those institutions designed and used for the care
and treatment of the insane.

^ I

LECTURE X

MEDICAL TREATMENT

We come now to consider the medical treatment
of insanity. The malady itself has been described in
its various forms, and while it is interesting to know
all that can be learned concerning disease, — concern-
ing its nature, causes, courses and natural conclu-
sions, the most intensely interesting part of medicine
is that which relates to the cure of disease; or, if that
is impossible, to the relief and comfort of those who
suffer from incurable maladies.

Having considered that part of the treatment
which relates to hygiene, to sanitation, to diet, to
physical rest and repair, we shall now seek to study
the art of applying medicine for the cure or relief of
the insane. Hahnemann was exceedingly particular
about diet and rest, and the avoidance of all exciting
causes of physical and mental disorder. But above
and beyond all these, he laid peculiar and emphatic
stress upon the curative value of properly selected
and carefully administered drugs.

In prescribing a remedy for the cure or relief of in-
sanity, as for any other disease, we have, as compre-
hensive physicians, to consider :

1. The pathological conditions which exist in the
physical structure.

2. The mental aberrations which accompany or
follow the physical disturbance ; and

3. The totality of symptoms as evolved by a
careful study of the history of each individual case.

AND THEIR TREATMENT. 233

Again, we find that sometimes a given form of in-
sanity leads to a specific group of remedies.

Whenever you are called upon to treat a case of
mental disease, you should make a careful exami-
nation —

1. As to the physical condition of the entire
system.

2. You should seek to discover all abnormal
states of the body which may by any possibility lead
to a disturbance of the mind.

3. You should seek to discover the various de-
partures from the normal mental status. (Some
patients are very cunning, and will deceive the phy-
sician unless he makes a most thorough and per-
sistent investigation of the case).

4. You should make note of all the symptoms
gathered, and having these as a basis for your pre-
scription, you should seek to select the indicated
remedy according to the Law of Similars.

Let us now turn our attention to a few remedies
for melancholia. It has long been supposed that
Aurum Metallicum was a princely remedy for sui-
cidal melancholia. Our experience has not sustained
this theory. Aurum has often been prescribed in ap-
parently indicated cases, but usually without good
effects. We have a remedy in the Materia Medica
which has worked very satisfactorily in cases of rest-
less, resistive, agitated and suicidal melancholia, and
that remedy is Arsenicum. The patients that Arseni-
cum has relieved have been those whose physical con-
dition would naturally suggest the administration
of that drug. These patients have been much ema-
ciated, and have had wretched appetites. They pre-
sent a dry, red, tremulous tongue; they exhibit a

shriveled skin, and a haggard and anxious counte-
16

234 MENTAL DISEASES

nance. They look as if they had suffered the tortures
of the damned, and that the fiends of hell were still
getting in their fine work. The Arsenicum case is
very thirsty, but is easily satisfied with a small
quantity. The Arsenicum patient is not only inclined
to wear himself out by constant exercise, but he is
likewise inclined to kill himself, or, failing in that, he
is apt to mutilate the body by chewing the fingers,
by pulling out the eyelids, by scratching holes in the
face and scalp, and by torturing the flesh generally.
For acute melancholia, where the victim is pros-
trated by shock, where the grief is intensely pro^
found, where the power of weeping, and thus secur-
ing relief, has been abolished, there we find Ignatia
Amara the relieving remedy. Probably no drug has
produced more comforting results in the realms of
sorrow and of loss than the St. Ignatius bean. The
Ignatia patient wants to be left alone, and is yet
sensitive about what she conceives to be the neglect
of her friends. For brooding sorrow, following hard
luck or bad news, give Ignatia. For the overmas-
tering effects of good news, which impel some women
into the hysteric state, give Coffea. While the Ig-
natia patient generally broods, she sometimes be-
comes hysterical, and indtdges in temporary fits of
laughter. The Natrum Muriaticum patients instead
ol brooding over their troubles or crying inwardly
(Ignatia), bubble and boil and shed tears copiously
like the old prince and king over their alleged dead
brother, as described in ** Huckleberry Finn." The
more you attempt to quiet them, the more effusively
they weep. If contradicted, they become ill-humored
and easily provoked, like Chamomilla and Bryonia.
Natrum Muriaticum patients are generally thin and
anemic, and have a prematurely old age appearance.

AND THEIR TREA TMENT, . 235

This remedy is often indicated in cases of melancholia
following intermittent fever, and when the patients
have periodic attacks of violent weeping.

Among the cry baby remedies we have Pulsatilla,
Nux Moschata, and Cactus. The Pulsatilla patient
weeps easily, but smiles through her tears, and is
very changeable. The mental state of Pulsatilla is
like the weather in April, now you see the brilliant
radiance of the summer's sun as it glints down from
cerulean-hued heavens; and again, you see gray
skies, or feel the trickling tears of the clouds.

The Cactus patient is sad and hypochondriacal;
not inclined to speak; weeps quietly but steadily.
And for accompanying symptoms there are marked
palpitations of the heart, with heavy pressure in the
head as if a weight lay on the vertex, and pulsations
in the top of the head.

Nux Moschata is a remedy for a melancholy per-
son with hysterical tendencies. The mood is change-
able; one moment the patient laughs, and the next
cries. Mental activity under Nux Moschata is
greatly depressed. The ideas are confased, more so
than in Pulsatilla, and there is an inability to con-
tinue a train of thought for any length of time.
There is loss of memory, and a stupid condition like
Anacardium, Opium, and Phosphoric Acid. In speak-
ing or writing, Nux Moschata patients are given to
dreamy incoherence of expression.

Digitalis is a remedy that is useful in melancholia
with stupor, or in any depressed state when the
pulse is slow, and the general circulation throughout
the system very stagnant, and when the eyes seem
to be brimming with tears.

Gelsemium is called for in melancholia when there

236 MENTAL DISEASES

is much fever, a general dullness of the mental facul-
ties, and a desire to lie in bed and be let alone.

Opium is sometimes used in chronic melancholia
when there is vivid imagination, and when the pa-
tients are easily frightened; or when there are
marked stupidity and hopelessness, with contraction
of the pupils.

Veratrum Album is called for in melancholia
when physical prostration and mental hopelessness
follow an outbreak of maniacal excitement.

Actea Racemosa, Lilium Tigrinum, and Sepia
are important remedies in the treatment of melan-
cholic women who are suffering with ovarian or
uterine troubles. The mental depression in such
cases seems to arise from an abnormal condition
of the generative organs. Both Lilium and Sepia
are full of apprehensions, and manifest much
anxiety for their welfare. In the Sepia case,
however, there is likely to be found some serious
change in the uterine organs, while the Lilium case
presents either fiinctional disturbance, or compara-
tively superficial organic lesion. Lilium is more
applicable to acute cases of melancholia when the
uterus or ovaries are involved in moderate inflam-
mation, and when the patient apprehends the pres-
ence of a fatal disease which does not exist. The
Lilium case quite speedily recovers, much to her own
surprise, as well as that of her friends. The Sepia
patient is despairing, somewhat suicidal, and averse
to work or exercise. This remedy is called for most
frequently in cases of long continued uterine disorder,
and consequent mental depression.

Actea Racemosa acts in a more general and less
specific manner than either Lilium or Sepia. The
entire nervous system is affected by the use of

AND THEIR TREATMENT, 237

Actca, and the condition produced is that of a
depressing irritant. The female sexual organs are
profoundly impressed by this drug. The menses be-
come erratic and delayed. At the same time the
patient feels as if her mind were wrapped in a deep
black cloud. She also feels as if she were going
crazy, and as if death were impending. Intense
mental depression, with spasmodic seizures during
menstruation, headache in the back of the head, ex-
tending over the neck, with rheumatic pains in the
muscles of the neck and back, are some of the indica-
tions for Actea in melancholia.

We w^ill now consider a few remedies which have
been used successfully for the cure of mania; and,
first of all, we will present that medical **01d
Guard" composed of the **Big Four'' therapeutic
veterans — ^namely, Belladonna, Hyoscyamus, Stra-
monium, and Veratrum Album.

Probably no remedy in the Materia Medica pos-
sesses a wider range of action, or a greater power
for relieving distressing symptoms in the brain than
Belladonna. Its symptoms are clear and well-
defined. Its action is sharp, vigorous, and profound.
It is a powerful supplementary ally of Aconite in
clearing away the last vestige of cerebral conges-
tion ; and beyond this it subdues effectively the
subtle processes of inflammation. Its symptoms are
familiar to every student of Materia Medica, but it
may be well to state, just here, that in a case of in-
sanity where Belladonna is indicated you will find a
hot, flushed face (the face is bright red throughout),
dilated pupils, throbbing arteries, a fixed and savage
look, with now and then sudden spasmodic ebulli-
tions of rage and fury. The Belladonna patient
tosses in vague uncertain restlessness. He attempts

238 MENIAL DISEASES

to bite, strike, tear clothes, strip oflF clothing, and
make outrageous exhibitions of the person, not on
account of lecherousness like Cantharis, but because
of a disposition to destroy everything that is reach-
able or tearable. The Belladonna patients are ex-
ceedingly fickle, and constantly changing in their
mental states. They change suddenly from one mood
to another, just as the pain of Belladonna comes
suddenly and goes suddenly. They sometimes dancei
and sing, and laugh for a short time. But all their
moods end in a cyclonic outburst of violence and in-
tolerable rage. Belladonna produces these conditions
and symptoms when taken in material doses, and it
has relieved, and probably cured, many a case of in-
sanity.

There are two rather opposite conditions existing
under the influence of Belladonna. In overpowering
doses the Belladonna patient, after the first period of
excitement, becomes dull and heavy, with stertorous
breathing, and dark-red besotted countenance, some-
what similar to that of Gelsemium. On the other
hand, we find other Belladonna cases exceedingly ex-
citable and nervous, and inclined to move all the
time. These are the extreme effects of Belladonna —
either a stupid, apoplectic condition on the one hand,
and on the other the light, loquacious, active, ex-
cited, and restless state of mind. The excitable
patient will become quiet under small doses of Bella-
donna — that is, from the third to the thirtieth
potencies, while the stupid patient seems to require a
large dose — that is, the first centesimal, or even the
first decimal dilution.

Hyoscyamus is a remedy that is called for when
there is a lower grade of maniacal excitement than
that which calls for Belladonna. The Hyoscyamus

AND THEIR TREATMENT. 239

patient is very exuberant in his expressions, but less
frenzied than the Belladonna case. Hyoscyamus is
very talkative, mostly good-natured and jolly. Oc-
casionally he has savage outbursts, and is inclined to
be destructive of clothing. The Hyoscyamus patient
exposes the person because of lecherous thoughts
and obscene tendencies. In this respect Hyoscyamus
diflfers from Belladonna. As I have said, Belladonna
tears oiBF clothing for destructiveness ; Hyoscyamus
tears oflF clothing for the purpose of exposing the
person, and for the purpose of exciting the passions
of others. The Hyoscyamus patient is jolly and in-
clined to talk very much, and for this reason it is a
suitable remedy for young, hysterical, nervous, and
easily excited women.

The Stramonium patient unites some of the char-
acteristics of Belladonna, Hyoscyamus, and Vera-
trum Album. The Stramonium case is even more
fierce than the Belladonna case. He has laughing fits
like Hyoscyamus, or rather like a hyena ; he waxes
eloquent and pathptic in his despairings of salvation
like the prover of Veratrum Album ; and he is also
greatly troubled with hallucinations. Everything
seems to be dark before his eyes. He swears at and
makes threats against imaginary foes. He has
periods when he is ready and "spoiling for a fight."
But for the most part, the Stramonium case is an
arrant and crouching coward. He sees animals, of
strange varieties and gigantic proportions, leaping
at him from the floor or the side-walls, and he is
greatly terrified by these apparitions.

Now remember this group of facts : Belladonna is
fierce and brave; Hyoscyamus is jolly and compan-
ionable; Stramonium is wild and cowardly; Vera-
trum Album is hopeless and despairing, or wildly

240 MENTAL DISEASES

plaintive, and beseeching for his salvation, which is
apparently lost.

Veratrum Album is a remedy whose sphere of use-
fiilness comprehends both profound prostration of
the physical forces, and a most shattered condition
of the intellectual faculties. The fame of this drug-
extends over a period of more than three thousand
years. It is related that about the year 1500 before
the Christian Era, a certain Melampus, a celebrated
physician among the Argives, is said to have cured
the daughters of Proteus, King of the Argives, who,
in consequence of remaining unmarried, were seized
with an ** amorous furor'* and afiected by a ** wan-
dering mania." These women had what is now
called **old maid's insanity." They were cured
chiefly by means of Veratrum Album given in the
milk of goats which had been fed upon that plant.
We have verified the use of Veratrum Album in
** wandering mania," especially when the symptoms
of peculiar excitement and tendency to travel are
accompanied by great mental distress and physical
collapse.

The Veratrum Album patient combines, as pri-
mary effects, the wildest vagaries of the religious en-
thusiast, the amorous frenzies of the nymphomaniac,
and the execrative passions of the infiiriated demon^
each striving for the ascendency, and causing the un-
fortunate victim to writhe and struggle with his
mental and physical agonies, even as the dying Lra-
ocoon wrestled with the serpents of Minerva. This
anguish is short-lived. The patient soon passes from
an exalted and frenzied condition into one of pro-
found melancholia — abject despair of salvation, im-
becile taciturnity, and complete prostration of both
body and mind. The extremities become cold and

AND THEIR TREATMENT, 2A\

blue; the heart's action is weak and irregular; the
respiration is hurried, and all the objective symptoms
are those of utter collapse. The physical state is like
that of a case of cholera. At the same time the mind
passes into a stygian gloom from which it slowly, if
ever, emerges. With such a picture before us we can
scarcely hesitate in the choice of a remedy, and
Veratrum Album is the one to be selected. There
are, of course, cases which are past the grace of med-
icine, yet the earnest use of this long tried drug has
frequently repaid us by marked improvement follow-
ing its administration, and in some cases Veratrum
Album has seemed to complete the cure.

We have portrayed a few characteristic symptoms
of four drugs for the cure of insanity of the maniacal
form. We might add to the list Aconite, with its
high fever, its mental anxiety, its restlessness and
fear of death. We might also speak of Veratrum
Viride which has likewise an exalted temperature, a
rapid pulse, great restlessness, fear of being poisoned,
and yet withal an indifference to death, w^hich is in
sharp contrast with the mental state of Aconite.
Veratrum Viride is often indicated in the maniacal
attacks to which epileptics and paretics are subject.

Again, we might speak of Nux Vomica, which is a
valuable remedy in subacute mania, where the pa-
tient is suspicious, and indulges in delusions of perse-
cution and wrong. The Nux Vomica patient is obsti-
nate, incorrigible, cross, ugly, and sometimes studi-
ous. Bryonia is also an ugly remedy. The Nux
Vomica patient moves about, while the Bryonia pa-
tient keeps still because all his symptoms are aggra-
vated by motion.

We might also speak of Lachesis, which is a
remedy for those who are extremely sensitive and

242 MENTAL DISEASES

persistently loquacious, and who indulge in the
strange and fantastic idea that they are dead, and
that preparations for the funeral are going on. The
prover of Lachesis feels as if death had overtaken
him, because of the profound and depressing effects
of that powerful drug. The blood rot of Lachesis is
only outrivaled by the blood rot of Baptisia Tinc-
toria. The victim of the latter thinks that he is all
to pieces and scattered about, while Lachesis only
thinks that he is dead, and gathered to his fathers.

Rhus Toxichodendron is of service in acute mania
when there is a rheumatic history, an excessive
restlessness at night, and when the patient is pos-
sessed of strong delusions of being poisoned. (Also
Hy oscyamus and Veratrum Viride) .

Tarantula is a remedy for crafty, cunning mani-
acs — ^patients who are full of mischief, and prone to
sudden fits of destructiveness, such as knocking
down pictures, or sweeping bric-a-brac from a man-
telpiece, or pounding a piano, or a helpless chUd.

Sulphur is useful in mania as an intercurrent
remedy. Also for ** fantastic mania" when the pa-
tient decks himself with gaudy colors, and puts on
old rags of bright hues, and fancies them the most
elegant decorations. Sulphur seldom achieves a cure
by itself, but sometimes it seconds with vigor the
efforts of other drugs.

When there is great sexual excitement in mania,
it may be relieved by the use of Cantharis. The
Cantharis patient has frenzied paroxysms of an ex-
alted type like Belladonna. The victim of this
remedy bites, and screams, and tears his hair, and
howls like a dog. As an invariable accompaniment,
there is also great excitement of the sexual organ-
ism. In this latter respect, Cantharis resembles Hy-

AND THEIR TREATMENT, 243

oscyamus and Veratrum Album, but these latter
drugs commingle the psychical with the physical, the
Hyoscyamus patient displaying lively fancies in con-
nection with erotic desires, and the Veratrum Album
patient uniting religious sentiment with lustful ten-
dencies; but the Cantharis patient, on the other
hand, is strictly and solely the embodiment of lechery
for lechery's sake. This is a result of an intense
erethism and inflammation of the sexual organs, im-
pelling the victim to seek immediate physical gratifi-
cation.

Cases of dementia may require Anacardium if the
patients are inclined to swear ; Apium Virus if the
skin is puffy and smooth, and when there is inac-
tivity of the kidneys; Calcarea Carbonica, when
patients are fat, flabby and pale; Calcarea Phos-
phoricum, if there seems to be a tendency to cere-
bral chilblain; and Phosphoric Acid when the pa-
tients are dull and drowsy, with occasional periods
of excitement, and profuse discharge of urine. In
cases of profound mental depression and mental
obfuscation — conditions which suggest both melan-
cholia and dementia — when the nervous system is
greatly exhausted, and when there are hysterical
tendencies, and when the flow of urine is very pro-
fuse. Phosphoric Acid is a leading remedy.

In masturbatic dementia we give Agnus Castus,
Causticum, Cantharis, Damiana, Picric Acid, Phos-
phorus, Phosphoric Acid, Staphisagria, Nux Vomica,
and Opium.

In epileptic dementia we sometimes find Bella-
donna, Cuprum Aceticum, Laurocerasus, CEnanthe
Crocata, and Solanum Carolinense of service in re-
lieving unfortunate symptoms. CEnanthe Crocata
has done much good in the relief of epileptic in-

244. MENTAL DISEASES

sanity. Solanum Carolinense has been used, but its
effects seem to be cumulative, and while the fits may
be checked for a season, they return with renewed
vigor, and in a dangerous way. Silicea, thirtieth, has
been one of the most satisfactory remedies in effect-
ing a wholesome change throughout the general phy-
sical system of the patient. As a health-developer
in epilepsy, Silicea ranks. as one of the first remedies
on the list. In medicating epileptics, you should be
carefiil and not overdo the work, and refrain from
giving too much medicine. You should regulate the
life, the diet, and the exposure to heat and wind.
You should encourage the individual to a philosophi-
cal and natural state of living. You should provide
against the injury of the patient during fits, by cov-
ering everything that is hard, and by lining and pad-
ding everything which he is likely to strike. All
sharp corners should be removed or covered in the
room where the epileptic lives. His diet should be
plain, w^holesome, light, and not stimulating. If you
give large doses of medicine and subdue or conceal
the fits for a time, you subsequently find that you
have simply postponed the evil day. You have
worked cumulative damage to your patient, and you
have perhaps driven an otherwise quiet and harm-
less case into the toils of maniacal excitement, or in-
to the deepest and most damnable depths of de-
mentia.

For the relief of general paresis, we may suggest
Mercury in its various forms. Nitric Acid, Iodide of
Potash ; Sulphur and Aurum if syphilis is suspected ;
and for the relief of the epileptiform seizures, Vera-
trum Viride, Cimicifiiga, Cuprum Metallicum, and
Laurocerasus. For the intense restlessness, anxiety,
and expansive ideas, together with rapid emaciation

AND THEIR TREATMENT. 245

of strength and flesh, you may use, according to the
symptoms, Aconite, Arsenicum, Belladonna, and
Cuprum. Alcohol produces artificial and temporary
paresis, and is therefore homeopathic to the genuine
article. It may be administered in small doses some-
times with benefit. Good whisky, in one-half ounce
doses, may be given once in three or four hours when
necessary. These remedies have thus far not proved
curative, but have sometimes afforded relief, and
have seemed to effect a prolongation of life, and an
increased comfort to the sick one.

Hospital Construction

During the past quarter of a century State hos-
pitals for the care and treatment of the insane under
homeopathic methods have been established in the
commonwealths of New York, Massachusetts, Min-
nesota, Michigan, California, and Missouri. There
should be a public homeopathic hospital for the care
of the insane in every state of the Union, because
there are believers in that school in every state.
Homeopathists pay a considerable proportion of
the taxes in each state. If they are denied the privi-
lege of homeopathic treatment when in mental dis-
tress, they are suffering not only with disease, but
likewise from the condition of taxation without
representation. Again, freedom of choice in medical
matters is a privilege that is just as sacred to the
individual as freedom of choice in any form of relig-
ious worship. In order to secure representation
wherever there is taxation, and in order to secure
absolute freedom of choice in medical matters, you,
as physicians, should seek to establish in the state
where you live a public hospital where mental in-

246 MENTAL DISEASES

valids may be treated in accordance with homeo
pathic principles.

In attaining this desired end, you should consider :

1. A suitable site for the proposed hospital.

2. The economical and durable construction of
both large hospital buildings and cottages for the
accommodation of the various grades of patients.

3. Ventilation, heating, and lighting.

4. Protection against fire.

5. Furnishings and decorations.

6. Congregate and ward dining-rooms.

7. Kitchen and bakery building.

8. Boiler-house, dynamo plant, and laundry.

9. Cold storage building for general supplies.

10. Outbuildings for stock of various kinds.

Site. — In selecting the site for a hospital you
should seek the moderate hilltops or sunny slopes of
protecting mountains, although you should at the
same time consider the difficulty of getting coal,
water, and provisions to their destination without
unnecessary expense. You should, if possible, locate
the buildings in such a place that you may have rail-
road communication direct to the institution; thus
the hospital will be siibjected to no heavy expense
for long cartage of coal, or other materials. A little
oversight on this point would lead, perhaps, to a
subsequent expenditure of thousands of dollars per
year, and without any real necessity for it.

Sites suitable for good sanitation must be at-
tained, but to these may properly be added the in-
spirations of grand and stirring scenery of either the
summits or the surf. Patients who are convalescing
from insanity are stimulated and helped to recovery
by the beauty or grandeur of the environments
which nature throws about them. It is said that

AND THEIR TREATMENT. 247

sea air has a soporific influence upon patients suffer-
ing with mania, \srhile the air and scenery of the
mountains are most inspiring and beneficial to the
victims of melancholia.

The soil of the site selected should be dry and
porous, or if it is a stiff clay, it should at least be
amenable to the influence of good drainage and culti-
vation.

Buildings, — The buildings designed for the care of
the insane should be located due north and south, or
a little east of south, in order to secure throughout
the year as much sunshine as possible upon the east,
south, and west sides of the buildings.

After many experiments, it has been determined
that hospital buildings for the insane should be not
more than two stories in height. The buildings
should be of moderate size, each accommodating
from twenty to one hundred and fifty patients.
Buildings of moderate size can be furnished with
light and fresh air more readily than large buildings,
and patients can be more easily classified in small
buildings than in large ones.

A public institution designed for the accommoda-
tion of twelve hundred or fifteen hundred patients
may properly consist of a series of buildings of mod-
erate size, and these, for convenience of access, and
for the ready distribution of food, may be connected
with each other by suitable corridors. If the site is
large enough, it is well to erect the buildings on the
borders of a large rectangle or parallelogram. With-
in the general enclosure of buildings and corridors
designed for patients may be situated a boiler-house,
a dynamo plant, a laundry, a kitchen and bakery,
an entertainment hall, and a library. In this
country, where changes in the weather are frequent

248 MENTAL DISEASES

and at times very pronounced, it is better to have
the institution so constructed that the patients may
go from all the wards to the library and the enter-
tainment hall and chapel without being obliged to
suflFer any exposure in the open air. By means of
suitable corridors from one building to another, the
officers and employees are also protected in the dis-
charge of duty from unfavorable weather.

The buildings should be constructed of brick with
hollow walls, and they should be sufficiently strong
for all practical purposes. The floors should be built
of steel girders and brick arches, overlaid with tile in
the water-sections, and paneled oak or body maple
in the wards. The ceilings should be of steel fash-
ioned into bright and attractive patterns, or the
brick arches may be plastered and painted. The side
walls should be of adamant cement, and every comer
should be made a quarter-round.

Each building should have a basement not less
than nine feet in height, and it should come well out
of the ground, in order that it may at all times be
supplied with fresh air, and as much sunshine as pos-
sible. The floor of the basement should be of cement
or stone. The basement floor should be laid in a
sloping fashion toward the drain, so that the base-
ment may be cleansed by hosing water over the
floors and into the drain pipes.

The hospital building should be divided into large
rooms, each containing thirty to seventy-five or
more beds. A few single rooms should be provided
in each hospital building. The hospital or reception
wards should be spacious and airy, with high ceil-
ings and numerous windows. Every hospital ward
should be provided with a solarium, or sun-room,
where the patients may secure the beneficial effects of

AND THEIR TREATMENT, 249

sunlight and fresh air at all times, and under the
most favorable circumstances. The open wards may
contain most of the patients, while the single rooms
can be used for the disturbed or the very sensitive.
Each ward should have easy access to a tower con-
taining baths, lavatories, water-closets, urinals, and
slop-sinks.

If it seems necessary to isolate some very dis-
turbed cases, they may be placed in one-story hos-
pital buildings detached from the main structures.
These buildings should be thoroughly lighted and, if
necessary, skylights, as well as side-lights, may be
used. But there are very few disturbed cases nowa-
days who do not become quiet more quickly if as-
sociated with others than if kept in absolute seclu-
sion. The seclusion of the noisy and the violent
should be only a temporary matter. We think that
at least sixty-five per cent, of the acute insane
may be properly treated in large hospital wards in
association with each other, and where trained
nurses may have their eyes upon all the patients all
the time, both day and night. By such means the
patients get constant nursing, and the method is
economical, as a nurse can take better care of half a
dozen patients if they are in one room, than he of can
three patients if they are isolated in single rooms. It
is thought by some that when a large number of pa-
tients are placed in one ward they will disturb and
annoy each other. This supposition is not founded
upon fact, because each patient is so absorbed in his
own thoughts that . he pays but little heed to the
thoughts and expressions of others. Hence the in-
sane do as well when they are in hospital wards as
when they are confined in small single rooms ; in fact,

it seems to me that the majority do better under the
17

250 MENTAL DISEASES

conditions of association. Occasionally there is a
patient who does not harmonize with his fellows, or
even tolerate them, and in such a case a small pri-
vate room should be afforded. Each person should
be considered from an individual standpoint, and he
should be favored with such surroundings as are
most likely to insure his speedy recovery. When pa-
tients begin to convalesce, they sometimes desire to
seek the seclusion which is afforded by a single room.
When they have secured all the benefits of treatment
in a general hospital ward, then they should be
granted the privilege of a room by themselves, or a
room in which two or three patients can be happily
associated.

Patients who have partially recovered in recep-
tion wards may be transferred to other suitable
wards, or to cottages w^hich are adapted to the care
of such cases. In wards and cottages for convales-
cent and recovering patients, it is often feasible to
practice what is called the ** open-door system." The
doors are unlocked during the daytime, and the
patients go out and come in at their pleasure, after
their tendencies have been observed, and their trust-
w^orthiness ascertained as fully as possible by the
attending physician. No patient should be permitted
to have an unrestricted parole until his mental con-
dition is such that he can appreciate the benefit and
feel the responsibility of such freedom.

If the hospital buildings are two stories in height,
then the floors should be thoroughly deafened, in
order to prevent the patients on the second floor
from disturbing those on the first, by shouting or
dancing above them.

Ventilation^ Heatingj and Lighting, — There are
several methods of enforcing ventilation in a hospital

AND THEIR TREATMENT. 251

^Bvard, but the sum and substance of them all is em-
bodied in the one word "draught." The foul air
must be made to move out, and the fresh air must be
made to come in, and these exchanges of impure for
pure air all depend upon the laws of motion.
The vital questions to be decided are :

1. How swift shall be the current of moving air;
and,

2. How frequently shall the air in a hospital be
entirely changed ?

A rapid draught may cause discomfort, or even
dangers to the patients. Rapid draughts of cold air
induce attacks of influenza, bronchitis, and pneu-
monia. If the volume of air moves too slowly
through a hospital ward, then there is danger that
some of the impurities may remain, and thus pro-
duce disease. It is claimed that the best and safest
rate of motion of air in a ward is about two miles
per hour. Much, however, depends upon the condi-
tion of the air itself— its temperature, and its humid-
ity. In summer ventilation may be secured through
windows and doors. The best method of window
ventilation is to raise the lower sash about six or
eight inches, and let down the upper sash about the
same distance. Much of the impure air is lighter
than common air; hence these impurities escape if
the upper sash is lowered. The currents of fresh air
coming in through the lower opening facilitate the
transmission of foul air to the upper regions. Some-
times the air becomes laden with carbonic acid gas,
and this being heavier than common air settles to
the floor. In removing this heavy foul air, the ad-
vantages of doors and French windows are plainly
apparent. With a door on one side of the room and
a French window on the other, the foul air that is

252 MENTAL DISEASES

heavier than common air is easily swept away. The
best ventilation by means of windows and doors
would be secured if each room or ward were supplied
with long doors on one side, and French windows,
on the other. These, when opened wide, favor the
free passage of air, and if there are enough of these
windows the atmosphere in a ward soon becomes
like the atmosphere out-of-doors — entirely pure, and
free from odors.

It should be the aim of all who are in charge of
hospitals for the sick to keep the air of the wards as
pure and fresh as that which is uncovered by any
roof, and which has been made fresh and invigorat-
ing by the cleansing blows of the pelting storm, and
the actinic rays of the noonday sun.

In winter the proper ventilation of wards and
hospitals is a more difficult task to accomplish than
during the summer. During the cold season ventila-
tion must be associated with the heating apparatus.
Fresh air should be sent into the wards by passing it
over hot steam coils or pipes filled with hot water.
Foul air must be taken away through conduits ex-
tending to the attic, and these should be connected
with a large cylinder supplied with steam pipes, to
rarify the air and produce a draught ; and above the
cylinder there should be constructed suitable ventil-
ators for the exit of the impure and exhausted air ol
the wards. By means of a suitable steam-heating
apparatus, fresh air may be driven into the wards
constantly'', and foul air may be drawn out of the
wards by the means already referred to. The impure
air is rarified by heat, and drawn up through pipes
or hollow tubing, until it reaches the peak of the

AND THEIR TREATMENT. 253

attic, and thence it passes into the open air through
suitable ventilators.

While the air in a hospital ward can be properly
heated and systematically distributed, and while the
impurities, as a rule, may be drawn up and forced
out at the top of the building, yet we believe that
the French w^indow and the open-door system of
changing absolutely and completely all the air in the
ward should be resorted to from time to time. By
the ordinary processes of heating and ventilation,
the air is, for the most part, kept in a fairly pure
state ; but some of the fresh air is constantly coming
in contact with the impure air which has not yet
wholly departed, and consequently there remain,
even in a w^ell- ventilated ward, some of its native and
inherent impurities. These can be removed only by
an absolute, speedy and complete change, by open-
ing all the sides of the house, so to speak, at suitable
intervals — that is, by opening the French windows
and the doors.

The heating of a hospital building may be carried
on by the indirect method, or by the direct-indirect,
or by the direct method. By the indirect method the
steam coils are all kept in the basement, and thus
space is economized in the ward. The indirect
method is best for violent, or disturbed, or epileptic
patients, as such patients are less liable to be injured
by the indirect method of heating than by the direct.
When the radiators are in the wards the epileptic
patients almost inevitably fall upon them when hav-
ing fits; and now and then a violent patient will
attack a radiator when it is hot as if it were an
enemy, and in that way he gets burned.

The direct-indirect method of heating is a combi-
nation of direct heating, and ventilation from out of

264 MENTAL DISEASES

doors. The same objections apply to it as to the
direct method.

The indirect method is probably the best, except
that it may have to be supplemented in cold corners
of the building by carrying the steam direct to these
exposed points. The steam-heating of hospital build-
ings has been carried to a very satisfactory pitch of
perfection, and this method of heating will probably
continue until superceded by electricity.

Some prefer the hot water method of heating, but
this system requires an excessive amount of large
pipes, and these occupy much space, and that would
be a serious objection if it were desirable to use the
direct method of heating. In case a pipe breaks in a
system where hot water is used for heating, the
flooding of the rooms and wards might be an addi-
tional objection.

Every hospital should be abundantly supplied
with sunlight during the day, and to this end large
windows and plenty of them are needed. During the
evening the wards should be favored with an ample
number of electric lights. These lights should be
covered with suitable shades, to protect the eyes of
the patients. Except during the sleeping hours, all
gloom should be dispelled as far as possible by the
introduction of light in almost unlimited quantities.
Darkness favors a continuance of gloomy thoughts,
while light tends to restore hope and happiness to
the human soul.

Protection Against Fire. — Every hospital should
be scrupulously protected against the ravages of fire.
Such protection is a prime necessity. In each large
public hospital there should be a well organized fire
brigade. The members of this brigade should con-
sist of those who work in the engineer's department,

AND THEIR TREATMENT. 255

and of the attendants and nurses who work upon
the wards. They should be regularly drilled at fre-
quent Intervals in the handling of apparatus to be
used for the putting out of fires.

There should be in each hospital a system of elec-
tric fire alarms, so constructed as to reveal, at the
outset, the exact location of the fire. There should
be an abundant water supply for fire purposes, and
it should be distributed by means of pipes through
every ward, and by means of hydrants on every side
of each building exteriorly. Each institution should
have a hose house, with an abundance of hose rolled
upon carriages. Everything that is needful for the
speedy attachment of the hose to the hydrants, in
case of conflagration, should be furnished, and kept
in the most convenient place. A portable chemical
fire engine is also a desirable addition to the fire ap-
paratus.

In addition to the foregoing, each ward of each
building should be supplied with portable fire extin-
guishers of approved pattern and tested capability.
Hand grenades, fire pails, water in barrels and tubs
should also be provided, and within easy reach of the
employees, especially at night.

Above and beyond all the measures heretofore
suggested, we believe that a system of automatic
fire sprinklers should be installed in every room, and
every ward, and every basement, and every attic of
every building devoted to the care of the Insane.
The greatest horror that can befall an institution
where the helpless sick Is housed is the calamity of
fire. It is almost Impossible to put out a fire when
once fairly started. Each ventilating shaft, or
clothes chute, or elevator passageway, becomes, in
the hour of fire, a chimney through which the flames

256 MENTAL DISEASES

are forced with a draught that equals the most elab-
orate and scientific boiler-house smoke-stack. Hence^
when a fire is once started, it is, as we have re-
marked, almost impossible to check it. Therefore, it
becomes our duty to prevent fires rather than to in-
dulge in the almost useless task of trying to put
them out after they are once started. Every new
building designed for the care of the insane should be
protected by a method known as the "automatic
fire extinguishing system.'' This system consists of
a series of pipes which pass to every ward and room
in each building. At proper intervals these auto-
matic sprinklers are placed, and when any one of
them is brought to a heat of 160°F., a cap, which
is held in place by soft solder, is released, and
a most vigorous diffusion of spray follows. This
spray strikes the ceiling, the side-walls, and the
floors, and is generally successful in extinguishing all
incipient fires. This system does not rely upon the
tardy discoveries of a sleepy night-watch, but it
works without direction or command, vigorously
and effectively whenever and wherever the first
flames of a kindling conflagration bring the heat
of a room or hall to 160°F. The automatic fire
sprinkler is probably the best and safest means for
the prevention of large fires, by putting out the small
ones while they are yet in an incipient stage of de-
velopment.

There should also be provision made in every hos-
pital for the speedy and safe escape of inmates from
the buildings in case a fire should occur. If future
structures designed for the insane shall be only two
stories in height, then the danger from fire will be
lessened. But in any event, it is wise to prepare
beforehand for every possible disaster. We have

AND THEIR TREATMENT, 257

examined into the merits of several varieties of fire
escapes, ranging 'from the simple [iron ladder to an
elaborate and wire-protected iron stairway. Down
the latter, when wide enough, sick patients may be
carried on cots, if they are unable to walk. But a
fire escape composed of iron "treads and risers" is
liable, in time of fire, to be filled with smoke and
flame, in which case it is almost impossible to utilize
it in those conditions.

Probably the best fire escape is a cylinder of steel
about six feet in diameter. The outer shell is com-
posed of steel plates tightly riveted together. With-
in is a spiral chute. This chute is fastened to and
supported by the external cylinder. In the center
is an iron pipe which may be used as a conduit
for water. The chute is fastened centrally to this
pipe. The cylinder is attached to the building in
such a way as to be easily accessible from each
floor. Down this steel spiral structure patients may
slide very rapidly without danger to themselves or
others. It is said that one hundred persons may
escape from a burning building in one minute
through a chute of this kind. People enter the
cylinder by passing through two iron doors, one
closing behind the person before the second is opened.
This keeps back the smoke and flame to a very large
extent. If the fire reaches and heats the cylinder at
any point, it may be cooled from without by the ap-
plication of a stream of water.

Pamisbings and Decorations. — Th^ furniture for
the use of the insane should be strong but comfort-
able, and of a pattern that will appear neat, that
can be readily cleaned, and that will not harbor
vermin. The bedstead should be of iron with woven
wire spring; and the mattress should be either of the

258 MENTAL DISEASES

best of hair, or the best of cotton felt. The cotton
felt mattress of proper quality is pliable and soft,
and does not get lumpy or mat like a hair mattress.
For these reasons the felt mattress seems to me to be
the most appropriate for bed patients. Patients
who are constantly in bed upon hair mattresses are
apt to have their skins irritated by the occasional
protrusion through the mattress of a sharp end of a
stiff and half-curled hair. This does not occur when
the best of elastic cotton felt is used.

Each hospital should be furnished, aside from a
bed and table for each patient, with large, easy rock-
ing chairs, and invalid chairs. We do not, however,
advocate the use of upholstered furniture, except in
the sitting-rooms of wards for the accommodation
of convalescent patients; for the reason that it is
quite easily soiled, and the expense of keeping it in
good condition is therefore considerable.

The furnishings and decorations of each room
should constitute an harmonious individuality by
itself, and yet all the rooms should be made to
harmonize with the ward. We think that the walls
should be painted in light colors, because they are
more soothing than dark colors. Pictures should
be placed upon the walls, and curtains at the win-
dows of both sitting-rooms and bed-rooms. A mis-
taken notion prevails that insane patients often
destroy such furnishings, but experience has tended
to prove the contrary. Only a very small percentage
of such patients destroy beautiful furniture or fur-
nishings. Rugs are preferable to carpets, as they
are more easily kept clean. Furnishings of a bright
and inspiring character not only tend to the beautify-
ing of a ward, but they may be classed as positive
curative agents. The lively interest which the pa-

AND THEIR TREATMENT. 259

tients take in any ne^w furniture that is placed upon
a ward is sometimes really remarkable.

Congregate or Ward Dining-rooms. — Much has
been written during the past twenty years about
associate or congregate dining-rooms. In institu-
tions having two thousand or three thousand pa-
tients, the interests of economy are conserved by
erecting large dining-rooms convenient to the wards,
and also adjacent to the kitchen building. Thus the
food may be served hot and promptly, with the
smallest practical number of attendants. These large
dining-rooms are very convenient and satisfactory
for the chronic insane who are able to be up and
dressed, and who can easily w^alk from the ward to
the dining-room; but for patients suffering with
acute insanity, who are obliged to remain in the hos-
pital wards, and much of the time in bed, the con-
^egate dining-room is, it seems to me, unavailable.
Attached to every hospital ward should be a con-
venient pantry and a small dining-room, where the
food may be quickly served when sent from the
kitchen. In every hospital for mental invalids there
is quite a considerable number of patients who are
sensitive as to their surroundings. These should be
placed on wards of moderate size, and there should
be a small dining-room attached to each one of these
wards. These patients may then be classified in such
a manner as to best conserve their general welfare,
and make them as happy as possible. A dozen con-
genial patients may sit down at a table in a small
room and enjoy their meals, \srhile if they w^ere forced
to eat in a large congregate dining-room, \\rhere the
table manners of some are highly objectionable, they
would be unable to take food in sufficient and sat-
isfying quantities. I believe that every institution

260 MENTAL DISEASES

should be provided with large dining-rooms and
small dining-rooms, arranged in such a manner as to
insure the best interests and the greatest possible
comfort of all concerned.

The objection to small dining-rooms is that they
require more help in the aggregate than the large
dining-rooms. But these small dining-rooms can be
looked after in such a manner as to be reasonably
economical in their management. The attendants in
small dining-rooms as soon as their work is finished
(and that is quickly done by the help of patients)
may then engage in the task of exercising patients
out-of-doors, and in performing such other duties as
may properly be assigned to them.

Kitchen and Bakery Building. — The kitchen and
bakery building should be separate from all other
buildings, aside from store rooms and cold storage.
There should be a narrow corridor connecting this
building with the basements of the other hospital
structures, and through which the food car may
pass. The kitchen and bakery building should be
large, light and roomy, and as nearly as possible fire
proof. The floors should be of Portland cement,
put down upon a solid and unchanging founda-
tion. The building should be so arranged as to re-
ceive all raw material at one side of the structure,
and the food, after it has been prepared, should be
sent out to the wards from the other side of the
building. The scullery should be so situated that all
soiled utensils coming back from the wards may be
washed before they get to the kitchen or bakery
again. The kitchen furniture should be capacious
enough for all possible needs of the hospital ; and the
boilers and ranges should be set up in such a manner
as to be convenient of access to those who must pre-

AND THEIR TREATMENT, 261

pare the food. Lack of room in the cooking estab-
lishment of an institution, or inconvenience of ar-
rangement, will tend to produce unnecessary strain
upon the workers, and this will finally result in
carelessness in one of the most important of all hos-
pital tasks — namely, the proper preparation of food.

Boiler-bouse, Dynamo Plant, and Laundry. — The
various buildings for heating, lighting, and laundry
work should be commodious and convenient. The
tendency at the outset is almost always toward a
too rigid economy, and a miserly stringency of space.
It is unwise to put up small buildings for an institu-
tion which may in time, by the addition of various
wings and wards, come to accommodate two thou-
sand or more patients. These necessary adjuncts to
hospital wards should be made fire proof and they
should be situated in the rear of the main building,
and as nearly as possible in the center of the inner
court— that is, if the hospital wards are grouped
about a large rectangle. If the linear plan of con-
struction is pursued, then these various buildings
should be in the rear of the main or administrative
building. For purposes of safety, and to avoid an-
noying the sick, the boiler-house, d3mamo plant and
laundry should be located at least three hundred or
four hundred feet from the wards.

Cold Storage Building. — ^A cold storage building
is now considered an essential necessity for the
preservation of meat, milk, butter, eggs, vegetables,
fhiit, and other perishable articles. With a cold stor-
age the authorities of an institution may take ad-
vantage of low market rates at certain seasons of
the year, and lay in a large supply as cheaply as
practicable. This building should be convenient of

262 MENTAL DISEASES

access to the kitchen and bakery, and large enough
to hold a three months' supply of food at the least.

Outbuildings for Stock of Various Kinds.— It
seems to be the policy of the various states to have a
farm in connection with each State hospital, hence
there is a necessity for bams, and stables, and pig-
geries, and other buildings for the accommodation of
the various kinds of stock. The task of caring for
horses, cows, pigs, chickens and ducks may be carried
on successfully by the aid of convalescent and intel-
ligent patients. These outbuildings should be located
so far away from the hospital that they cannot be-
come sources of annoyance to the patients.

The task of upbuilding a public institution for the
insane is a noble and a glorious one. It is an under-
taking worthy of the attention, the careful contem-
plation, and the best energies of any thoughtful man.
The upbuilding of an establishment, whose outlines
we have endeavored very briefly to sketch, is an
enterprise so lofty in purpose, and so beneficent in
results as to afford serene satisfaction to all who
may engage in the work.

In the heart of London, England, there stands a
magnificent structure known as St. Paul's Cathedral.
The architect of this gigantic and stately edifice was
Sir Christopher Wren. When his great work was
completed, he inscribed upon the rim of the grand
dome in the center of the cathedral this word, ** Cir-
cumspice,^^ which means in plain English, "Look,
around."

When the modem hospital is completed upon the
plans outlined in this lecture, then all the people
maybe invited to "look around," and behold with
pleasure the results attained when benevolence and
philanthropy, enlightened intelligence and enthu-

AND THEIR TREATMENT, 263

siastic energy, unite their forces for the purpose of
effecting that which is best in the care and comfort
and cure of mental invalids.

COMPENDIUM

We present herewith, alphabetically, a list of rem-
edies for taental disorders, with characteristic mental
and allied symptoms.

ACONITE

General Action, — Aconite affects primarily the
cerebrospinal and sympathetic ganglionic systems.
It stimulates the inhibitory centers of the pneumo-
gastric, and by hyperstimulation the pneumogastric
nerve becomes exhausted, as is shown by the heart's
action becoming quickened and more irregular, until
finally paralysis of the heart may occur. Aconite,
when given in large doses, produces inevitable cardi-
ac depression and a tendency to death. In less
poisonous doses, this drug produces acute inflamma-
tory action throughout the system. The precise
manner in which the inflammatory process is in-
duced by Aconite has not been satisfactorily ex-
plained, but it has been suggested that by causing
paralysis of the vasomotor nerves, the arterioles
dilate, doubling their capacity, and thus patients are
bled, so to speak, in their own vessels. Wherever
there is an excessive supply of blood, there is a tend- '
ency to inflammatory metamorphosis.

Brain and Spinal Cord, — Congestion of the brain,
with oversensitiveness to light ; heat and redness of
the face, or pale face; carotids pulsate strongly;
pulse full and strong (also Belladonna, Gelsemium,
Veratrum Yiride); headache as if the brain were

MENTAL DISEASES AND TREA TMENT, 265

moved or raised; burning in the forehead as if in
boiling water; vertigo; conjunctivitis; pupils con-
tracted or dilated; formication over the spine; numb-
ness of spine ; spasms from inflammation of spine ;
numbness and tingling of limbs ; paralysis of limbs ;
jerkings of arm and leg; nausea and vomiting of
cerebral origin ; the least noise, especially of music,
aggravates the brain symptoms.

Mind. — Great fear of approaching death; incon-
solable anguish ; dread of men ; fear of ghosts ; fears
the loss of reason ; mental prostration, with weak-
ness of memory ; cannot remember dates ; changing
mood, from dry anguish to exuberant tears; the
mind suffers from the effects of anger or fright.

Sleep. — Sleeplessness, with anxiety and mental rest-
lessness.

Accompaniments. — Full hard pulse aiid flushed
face ; hypertrophy of the heart ; pain in the cardiac
region ; and pain and tingling in the left arm.

Special Sphere of Action. — Aconite is indicated for
the restless mental anxiety in the victims of intense
shock. The state calling for Aconite is one of an-
guish, anxiety, and nervous excitement. It has a
marked influence upon the cerebral circulation, and
is useful for cases in which formerly venesection was
prescribed. In threatened apoplexy and apoplecti-
form seizures, when there are congestion of the brain,
vertigo, flushed face and thick speech, and when there
are intense anxiety and restlessness. Aconite will
often dispel or relieve these morbid symptoms, and
sometimes apparently avert an attack. Experience
in repeated cases has verified its usefulness under
these conditions. In mania and melancholia, with
intense restlessness, due to mental anxiety and nerv-
ous excitement, with great fear of death, whether
18

M I

266 MENTAL DISEASES

the condition is accompanied by fever or not, par-
ticularly in acute cases with marked sthenic symp-
toms, beginning with great violence, and when
symptoms are worse at evening, a few doses of
Aconite, given at short intervals during the early
part of the night, will often procure for the patient a
natural and restful sleep.

Aconite is of great service in the convulsions of
paresis ; also in those rapidly occurring convulsions
of epilepsy which constitute the status epilepticus.
Here Aconite seems to afford the relief which is said
to follow the removal of the cerebrospinal fluid by
lumbar puncture.

Almost daily, by the use of this drug, we are able
to check beginning inflammatory conditions caused
by exposure to unusually cold draughts, and the
early use of this drug in such cases is doubtless one
reason why, at this hospital, there has been so little
pneumonia in the past twenty-five years.

AGARICUS MUSCARIUS

General Action, — This fungus is classed by toxi-
cologists as a narcotic, acrid poison (Christison). It
acts upon the blood, rendering it fluid, so that it
runs easily from the bodies of those killed by it ; it
produces gangrene in the stomach and intestines.

Brain and Spinal Cord. — Agaricus produces con-
gestion of the brain, with stupidity; heaviness of the
head as if intoxicated ; the spine is sensitive to touch ;
there are severe burning pains in the spine, with jerk-
ings or tremblings of the facial and cervical muscles.

Mine/.— Confusion of mind; unable to find the
right word when speaking (compare Alumina, Cal-
carea Carbonica, Chamomllia., and Lycopodium);

AND THEIR TREATMENT. 267

disinclined to answer questions ; sings and talks, but
will not answer when spoken to ; indisposed to per-
form any labor, especially mental; ill-humored and
irritable ; merry and singing in ecstacies ; and again
prostrated by general malaise ; people who are so-,
licitous and anxious about ordinary afFairs become,
under the effects of Agaricus, moody and indifferent
to their surroundings.

Sleep. — Irresistible drowsiness in the da3rtime ; on
falling asleep the muscles of the body twitch sud-
denly, and the patient awakens.

Accompaniments, — Severe pains in the stomach;
grass-green diarrheic stools; cutting pains in the
abdomen, and sometimes dysenteric discharges.

Special Sphere of Action. — Paretic conditions after
sexual and other debauches ; mental obtuseness, with
ill-humor; trembUng and twitching of groups of
muscles; coma following febrile or mental excite-
ment ; general paresis, mania and primary dementia.

ALUMINA

General Action. — The most characteristic effects of
this substance are evidenced in motor weakness and
sensory disturbance of the lower extremities, and in
extreme dr3mess and irritation of the mucous mem-
branes. The secretions are thick, scanty, and acrid.

Brain and Spinal Cord. — Stitching burning pain
in the head, with vertigo, worse in the morning, but
relieved by food. Burning pain in the spine, as
though pierced by a hot iron ; numbness of the legs,
as though walking on cushions. Arms and legs
heavy, as though paralyzed; legs weak and easily
tired ; cannot walk without the aid of vision.

Mind. — ^Low-spirited and hypochondriacal; little
obstacles seem insurmountable ; is peevish, whining,

268 MENTAL DISEASES

and always ready to give up. Thoughts of suicide
are suggested by the sight of possible means of its
accomplishment, but are repugnant, and contribute
to the patient's suffering. Time seems long; joy in
work is gone ; the consciousness of personality is ob-
scured ; memory fails ; and complete loss of reason is
dreaded. These symptoms grow better as the day
advances.

Sleep. — Lassitude during the day, with an inclina-
tion to lie down. At night is restless, and disturbed
by anxious dreams; awakens with palpitation of
the heart.

Accompaniments. — Dyspepsia, with capricious ap-
petite; rejects nourishing food, and wants unusual
and indigestible articles. Constipation, dry stools
passed by great straining. Atrophic catarrhs of the
upper respiratory passages, with scant, thick, tough,
yellow mucus; ropy tenacious leucorrhea; conjunc-
tivitis, the lids are cracked and stiflf.

Special Sphere of Action. — Alumina is most usefiil
in persons of advanced years, spare and wrinkled,
and illy nourished. It is indicated in the milder types
of melancholia, accompanied by considerable con-
fusion of mind, and a tendency to chronicity. It has
an extensive use in the spinal degenerations and
paralysis of the lower limbs, particularly in loco-
motor ataxia.

ANACARDIUM

»

General Action. — Anacardium depresses the intel-
lectual centers and the organs of special sense, with
sensations of general weakness and faintness.

Brain and Spinal Cord. — Severe, tearing, nervous
headache, or as though a plug were forced into the
brain, usually on the left side.

AND THEIR TREATMENT. 269

Mind. — Great weakness or total loss of memory.
Recollection of single names presents the greatest
difficulty. Irritable and passionate; irresistible de-
sire to curse and swear. It sometimes seems to the
distracted patient as though he had two separate
wills swaying him in opposite directions; cannot
apply the mind; hallucinations; seems to hear the
voices of absent relatives, or to smell filth ever be-
fore the nose, especially when smelling the clothes or
body.

Sleep. — Great sleepiness during the day ; mostly in
the forenoon.

Accompaniments. — Pain as if a plug were forced
into various parts of the body, especially in the
rectum, with constipation. Frequently hungry ; feels
better while eating, but aggravated afterward.

Special Sphere of Action. — Anacardium relieves
nervous headache, the result of overexertion, and the
weakness of memory and inability to think which
result from exhausting physical disease, or which im-
mediately follow the more violent symptoms of the
acute psychoses; and it is sometimes used, though
with much less success, because of the organic nature
of the disease, in the various forms of terminal de-
mentia.

ANTIMONIUM CRUDUM

General Action. — The antimonial salts attack the
mucous membranes, especially the lining of the
gastro-intestinal canal, producing vomiting, and in
poisonous doses purging, with profound depression
of the vital powers.

Brain and Spinal Cord. — Heaviness in the head,
with vertigo. Headache increased by going up stairs.
(Also Calcarea Carbonica).

270 MENTAL DISEASES

Mind, — Cross and peevish ; if only looked at is
anery; sulky, and wants no communication with
anfone ; sentimental ; has amorous longings, not for
any living creature, but for some unseen seraph
boded forth by an ecstatic imagination.

Sleep. — Sleepiness during the forenoon; sleeps
heavily, but is unrefreshed.

Accompaniments. — Thickening and irregular
growth of the skin and nails. The tongue is covered
with a uniform white coating. Watery diarrhea,
especially in hot weather, containing little lumps of
fecal matter, with vomiting of food, and anorexia.

Special Sphere of Action. — It is suited to the
mental condition of some young persons passing
through the critical pubescent period, whose grow-
ing interest in the opposite sex tends to center un-
healthfuUy in some bright Prince Charming, or in
some idealized, and perhaps entirely self-created
maiden. Moderate, regular occupation; plenty of
exercise in the open air; frequent association with
other boys and girls of a similar age under simple
natural conditions, and attention to the character of
the literature read, are cardinal accessories in the
management of such a case.

ANTIMONIUM TARTARICUM

General Action. — Similar to Antimonium Crudum,
with more nausea and retching, and greater circula-
tory depression. The heart's action is feeble; the
pulse soft and tremulous.

Brain and Spinal Cord. — Its characteristic eflfects
on the lungs, heart, liver, and stomach are brought
about by its action upon the origin of the pneumo-
gastric nerve. There is headache as if a band were
compressing the forehead. (Mercurius, Nitric Acid,

AND THEIR TREATMENT. 271

and Sulphur have the sensation of a hoop bound
tightly around the head).

Mind, — Restless and apprehensive ; does not want
to be left alone, yet cannot bear to be touched.

Sleep. — Yawning; irresistible desire to sleep;
awakened often by abdominal disturbance.

Accompaniments. — Inflammation of the smaller
bronchi, much rattling of mucus in the chest; numer-
ous fine bubbling rMes; oppression of breathing;
blueness of the surface and cardiac failure; green
watery diarrhea (Veratrum Album). A pustular
eruption on the skin.

Special Sphere of Action. — Antimonium Tartari-
cum is a remedy little called for in treating the
strictly mental manifestations of the insane, but of
frequent use in combating their physical ills. In
capillary bronchitis it should be given early, not, as
often the case, administered only afber the rattling of
death is heard in the throat, and no remedy can suc-
ceed. It is also of use in the gastric and intestinal
disorders which may follow when patients with im-
paired judgment overload the stomach, as they will
so frequently do if not watchfully guarded by an
intelligent and observing nurse.

APIS MELLIFICA

General Action. — It defibrinates the blood, and
causes inflammation of a low grade, in which the
tissues rapidly break down and become gangrenous ;
it also causes serous effusions. These blood changes
produce mental stupidity, and often coma.

Brain and Spinal Cord. — Hydrocephalus, with
piercing shrieks; vertigo, worse lying down (also
Conium); coma, with constant jerkings of the limbs ;
stinging pains in the back.

272 MENTAL DISEASES

Mind, — Stupidity, absent-mindedness, awkward-
ness; lets things drop from the hands (also Helle-
bore); loss of memory; moody; irritable; jealous
(also Hyoscyamus); mania from sexual excitement
in women ; fear of death, with sensations that they
are going to die.

Sleep. — Great inclination to sleep, but cannot do
so because of mental restlessness (Aconite and Cof-
fea); cramping and starting in sleep; unpleasant
dreams; dreams of flying and journeying.

Accompaniments, — Erysipelatous condition of the
face ; pain, and tenderness, and dropsy of the ovaries,
especially the right; scanty micturition, and some-
times a general dropsical condition.

Special Sphere of Action, — Mental stupidity, with
occasional periods of restlessness and screaming;
jealousy in women who suffer with sharp pains in
the ovaries, especially in the right.

ARGENTUM NITRICUM

General Action, — It leads to destruction of the
coloring matter of the red corpuscles; profound
anemia and malnutrition, followed by destructive
inflammations of the bones and periosteum; cerebro-
spinal disturbances, and fatty degeneration of the
muscles and glandular organs.

Brain and Spinal Cord. — Tetanic convulsions, pa-
ralysis, coma, and death from asphyxia follow the
administration of large doses. Headache deep in
the brain, or as if the cranial bones were expanding.
(Also Glonoin). Better with tight band around the
head (also Silicea). Spinal pains and weakness;
limbs are weak and imperfectly co-ordinated, with
vertigo, and trembling from nervous weakness.

AND THEIR TREATMENT, 273

Mind. — Irresolute and melancholic; hesitates to
undertake anything from fear of failure (also Arnica).
Feels as if under a mental cloud (compare Cimi-
cifiiga) ; and has no interest in ordinary employ-
ments. The memory is poor.

Sleep. — Restless; anxious, fnghtful dreams which
seem true on awakening.

Accompaniments. — Pain in the pit of the stomach,
which radiates in all directions; belching of large
quantities of wind; facial neuralgia, with a sour
taste in the mouth ; asthma ; spasms of the respira-
tory muscles; throat sore, dark red, and swollen;
purulent ophthalmia.

Special Sphere of Action. — It is useful in cases of
hypochondriasis and mental failure, accompanied by
flatulent or nervous dyspepsia, or caused by over-
indulgence in the use of alcohol, and excesses in
venery. It is indicated and successfully used in loco-
motor ataxia, and to a less extent in other forms of
sclerosis of the brain and spinal cord. Epileptic con-
vulsions followed by tremor have also been cured by
its administration.

ARNICA

General Action. — It slows up the action of the
heart, and raises the arterial pressure. There is capil-
lary stasis, and a tendency to hemorrhages in the
brain.

Brain and Spinal Cord. — Left-sided paralysis from
concussion; tired, weary feeling in the head, worse
on lying down ; sensation that everything feels hard.

Mind. — The Arnica patient has fits of anguish or
hopeless indifference ; forgets what he is reading, or
the word he is about to use (Anacardium, Lilium
Tigrinum, Lycopodium;; fears being struck by per-

274 MENTAL DISEASES

sons coming near him ; easily frightened ; unexpected
troubles make him start; answers questions very
slowly, sometimes falling asleep while answering.

Accompaniments. — Bladder affections of trau-
matic origin ; tenesmus, with spasms of the neck of
the bladder; general prostration from blows upon
any part of the body.

Special Sphere of Action, — Arnica is useful in cases
resulting from traumatism, particularly when men-
tal disturbance is traceable to injury about the head,
even though the injury occurred several years pre-
viously. Schroeder Van der Kolk claims that Arnica
is invaluable in certain cases of mania when the first
excitement has passed, and there remain a heat in
the head, and a tendency to imbecility. Arnica is
also of use after apoplectiform seizures and paralytic
symptoms which remain after apoplexy. The pa-
tient manifests weakness of memory, and confusion
of mind ; is absent-minded, complains of a bruised,
sore feeling, especially after concussion. This sensa-
tion of soreness, as though from a bruise, is charac-
teristic of Arnica.

ARSENICUM

General Action. — ^Arsenicum acts upon the gang-
lionic nervous system ; it acts upon the mucous and
serous membranes, producing in the former espe-
cially, inflammation of a low grade. There is a
marked tendency, under Arsenicum, of the tissues to
become gangrenous; also there are efiusions into
those cavities which are lined by serous membranes.

Brain and Spinal Cord.— The nervous system is
apparently affected, reflexly, by the disturbance of
the digestive apparatus; there is frontal headache,
and the pains are of a burning character ; there are

AND THEIR TREATMENT, 275

vertigo and tinnitus aurium; sensitiveness and burn-
ing in spine.

Mind, — Melancholia; and tearful and depressed
mood ; intense anxiety, with great restlessness ; fears
to be left alone lest he should do himself bodily
harm ; great fear, with cold sweats ; cannot find rest
anywhere; w^ants to move from bed to bed; is in-
tensely suicidal, and is inclined to mutilate the body ;
the patient has hallucinations of smell ; smells pitch
and sulphur, and anticipates consignment to sheol.

Sleep. — Sleeplessness, with restlessness and anx-
iety; frequent starting in sleep; awakened by pain,
especially after midnight; after sleep feels as if he
had not slept enough; dreams full of care, sorrow
and fear, about thunderstorms, fire, black water, and
death.

Accompaniments. — Asthmatic conditions ; diffi-
ctdty in respiration; thirst for small quantities of
water at frequent intervals ; weakness and palpita-
tion of the heart ; emaciation of the body, followed
by dropsical tendencies ; scanty urine, and burning
during micturition.

Special Sphere of Action. — Arsenicum finds a va-
riety of application among the insane in aflfections
characterized by periodicity, great weakness and
prostration, symptoms of a malign nature, restless-
ness and anguish, burning sensations, unquenchable
thirst for small quantities of water, and, very often,
pains which are worse at rest, and increased by cold.
It is usefiil when the patient is delirious, depressed,
restless, has fear of death, fear of being alone, and has
strong suicidal tendencies. There is often noticed a
tendency among the insane to mutilation of the
body ; picking the skin until it is sore, and chewing
the finger nails. Here Arsenicum relieves. This drug

276 MENTAL DISEASES

causes intense prostration ; hence it is usefal in those
cases of acute delirious mania and exhaustive insani-
ty which are accompanied by typhoid symptoms and
by rapid emaciation. We note especially its good
eflFects upon the victims of resistive and restless
melancholia, of active and ever-stirring mania, and
of rapidly failing paresis. Dr. Hughes states that Ar-
senicum is one of the few remedies which causes gen-
uine neuralgia, and far excels all other remedies in
the treatment of idiopathic disorder. There is intense
sensitiveness of the scalp under Arsenicum. This
drug is said to produce epilepsy, with opisthotonos ;
and is a valuable remedy in the treatment of epilepsy
when the paroxysms recur periodically. In sleepless-
iless it is pre-eminently an effective remedy for those
who are suffering from malnutrition, from emacia-
tion, and from blood degeneration, accompanied by
extreme exhaustion of the nervous system. Not only
is the brain anemic, but the entire body likewise.
By keeping a weak and exhausted patient in a prone
position both day and night ; by the liberal use of a
hot liquid diet ; and by the administration of Arseni-
cum as a restorative medicine, a subtle and charm-
ing effiect is speedily produced, as is evidenced by
pleasant and abundant sleep at night, and the rapid
regaining of health and spirits during the daytime.

AURUM

General Action. — Aurum affects the connective
tissues, producing degenerations of the bones, gland-
ular organs, and mucous membranes, similar to
those found in syphilitic, mercurial, or scrofulous
disease. Hyperemia accompanies all other symp-
toms as a pathological characteristic.

AND THEIR TREATMENT. 277

Brain and Spinal Cord, — Tearing headache deep
in forehead, with congestion of the brain, and worse
from mental work.

Mind, — Has no confidence in himself, and thinks
others have none ; has a feeling of self-condemnation
and worthlessness. Great mental anguish; tired of
life, and cannot keep the mind from thoughts of
suicide. The melancholia may be of a religious form,
when constant prayer may be the most noticeable
symptom. The memory is weak, and mental labor
is difficult.

Sleep. — Sobs during sleep, or screams aloud from
frightful dreams; wakeful during the night, but
without lassitude in the morning.

Accompaniments, — Fetid nasal discharge; caries
of the bones, especially about the nose and palate ;
rhinitis ; sees things double ; boring pain behind the
ear ; oflFensive otorrhea ; inflammation and degenera-
tion of the liver and kidneys; chronic orchitis, and
uterine prolapsus from congestion.

Special Sphere of Action, — Aurum has been con-
sidered the remedy in melancholia, and particularly
if due to syphilitic disease, or to the abuse of the
mercurials; but in our experience it has frequently
failed to accomplish the desired results.

BAPTISIA

General Action, — It disorganizes the blood, and
produces putrid conditions in all parts of the body,
with great prostration and exhaustion.

Brain and Spinal Cord, — Cerebral congestion;
face has a besotted appearance ; dull, heavy pain at
the base of the brain ; paralysis of the left side, with
numbness.

278 MENTAL DISEASES

Mind. — Confused as if drunk ; feels as if he were
sliding away; bed feels too hard (also Arnica);
thinks his body is scattered about, and struggles
constantly to get himself together ; restless, but too
lifeless to indulge in active exertion ; can be roused,
but before answering a question, falls asleep again.

Sleep. — Sleeps well till three a. m. (also Nux
Vomica); is then restless till morning; cannot sleep
because he thinks his head and body are scattered
about ; restless, with frightful dreams ; mutters in a
delirious way even while partially asleep.

Accompaniments. — Intensely fetid breath; dry,
hot mouth ; tongue very dry and brown, and marked
sordes on the teeth ; involuntary stools of a strongly
oflFensive nature ; the diarrhea is brownish in color,
and often looks like decomposed blood.

Special Sphere of Action. — Baptisia may be used
in mania and melancholia when there are stupor,
rapid and profound degeneration simulating the
typhoid state, and when the patient manifests the
peculiar mental symptom that he ** cannot get him-
self together.'* It is a singular fact that many in-
sane patients have the delusion that their bodies arc
scattered, and they cannot keep themselves in a state
of bodily contiguity.

BELLADONNA

General Action. — Belladonna acts upon the cere-
bro spinal system, causing intense cerebral hyper-
emia. There is a bright red face, dilated pupils,
intolerance of light, and violent spasms of the mus-
cles of the face, neck and arms.

Brain and Spinal Cord. — Severe headache, espe-
cially in the frontal region; the headache is of a
throbbing nature (also Glonoin and Cactus); the

AND THEIR TREATMENT, 279

pains come suddenly, and as suddenly depart; full-
ness of the head, with throbbing arteries; boring,
shooting pains in the head, all aggravated by noise.

Mind. — Belladonna develops two distinct states
of mind. One where the patient is flushed; the
mental powers seem unduly excited and exaggerated.
Hallucinations and illusions of sight are present ; he
sees giant forms; these sometimes excite fear and
laughter; a maniacal state in which the patient is
merry (also Hyoscyamus); most characteristic there
are fiirious delusions and rage; the patient tears
clothing, bites, strikes, kicks, howls, shrieks, and
wants to get away. There is a contrary state where
the patient passes into a stupid and dazed condi-
tion; the pupils remain widely dilated; the eyes
are staring and insensible to -light ; there is heavy
stertorous breathing; the face is purplish red; the
patient refuses to speak; there is marked rigidity
or steady tension of the muscles; and occasionally
there is low muttering delirium.

Sleep, — Sleepy, yet cannot sleep (also Gelsemium);
jerking of the limbs in sleep; dreams of murder, of
robbery, and of danger from fire ; sleeplessness from
excessive cerebral hyperemia.

Accompaniments, — Spasmodic condition of all
the sphincter muscles ; paralysis of the left side, with
twitching of the muscles of the right side ; bright red
condition of the skin; active inflammatory condition
in the throat, chest, kidneys, bladder, and genital
organs.

Special Sphere of Action. — It is particularly use-
ful in conditions of mental excitement in any form
of insanity. It is indicated in full-blooded people,
with a tendency to cerebral hjrperemia, in threat-
ened apoplexy, and in insanity following acute

280 MENTAL DISEASES

diseases. In his mania the patient is likely to be
wild, fierce, trying to escape, or to injure those who
are in attendance upon him. He manifests a pugna-
cious disposition which renders him an unpleasant
person to care for. His eyes are bright, the con-
junctivae are congested, the pupils are dilated, and
the mucous membranes are dry, particularly about
the throat. The skin is hot; the face is flushed.
Later the patient .may become dull and stupid, dis-
inclined to answer questions, and unwilling to be
disturbed. Belladonna is also useful in the beginning
of meningitis, having an active influence in control-
ling cerebral hyperemia, and subduing with remark-
able efficacy the processes of inflammation.

BRYONIA

General Action. — Serous membranes are especially
afiected by Bryonia. This drug seems to have
marked affinity for the pleural coverings of the
lungs, and for the peritoneal linings of the abdomen.
Again, it affects the joints, producing rheumatic
pains ; and it likewise pays its respects to the brain
and its membranes, producing symptoms of active
and intense congestion.

Brain and Spinal Cord. — Head feels confiised and
foil as after a night's dissipation; there is frontal
headache extending backward to the occiput (Bella-
donna, Spigelia, and Gelsemium have headache run-
ning from the occiput to the forehead); headache as
if the head would burst ; this pain grows worse dur-
ing the day, and is aggravated by motion ; head feels
too foil, and there is much vertigo.

Mind. — Depression and moroseness without cause;
the patient is irritable and wishes to be alone (also
Coca) ; is obstinate and passionate, and is troubled

AND THEIR TREATMENT. 281

with what has been called "pure cussedness" (also
Nux Vomica); the patient worries much about busi-
ness affairs.

Sleep, — Sleep is very restless; during sleep is
troubled with somnambulism; sleeplessness from
thoughts crowding upon each other ; dreams about
the business of the day.

Accompaniments. — Cough, usually dry, but some-
times there is sputum which is streaked with blood ;
cannot take a deep breath; stitching pains in his
side, aggravated by motion; sensation as if the head
and chest would fall to pieces on coughing ; intense
thirst for large quantities of water.

Special Sphere of Action. — Characteristics which
call for Bryonia are : An apathetic mental condition,
ranging from languor to torpor, aggravated by
motion of the head. The patient is disposed to be
irritable when disturbed or aroused, and the remedy
is useful for the bad effects following the manifesta-
tions of violence and anger. It is not a remedy on
which we rely greatly in the cure of mental disease,
yet it often relieves attacks of acute physical disease.
It has been of especial service in epidemics of influ-
enza or la grippe ; in congestions following exposure
to cold, and when there has been a tendency to dis-
eased conditions of the serous membranes. It is a
usefikl remedy in constipation occurring among the
insane when the stools are large, dark and dry as if
burned, and expelled with great difficulty.

CACTUS GRANDIFLORUS

General Action. — ^This drug appears to have a

special affinity for the heart and its nerves, causing

more or less irregular action; constricting pain

about the heart, with anguish.
19

282 MENTAL DISEASES

Brain and Spinal Cord, — Throbbing pains in the
vertex of the head, and along the spine.

Mind. — Melancholia ; unconquerable sadness ; fear
of death (also Aconite) ; believes his disease incur-
able (also Ignatia, Lilium Tigrinum, Natrum Muri-
aticum, and Sepia).

Sleep. — Sleeplessness, with pulsations at the pit of
the stomach ; palpitation of the heart, and a sensa-
tion of palpitation in the top of the head ; delirium
at night and during sleep, which ceases on awaken-
ing. (Also Gelsemium).

Accompaniments. — Sensation as if an iron band
were about the heart, preventing its normal move-
ments ; pain in the apex of the heart, shooting down
to the fingers of the left hand ; irregularity of the
heart's action, now rapid and again slow^; slow
pulse (also Digitalis).

Special Sphere of Action. — Melancholia, partic-
ularly in women, with a sensation of constriction
about the heart ; palpitation of the heart, and a cor-
responding palpitation on the top of the head.

CALCAREA CARBONICUM

General Action. — This drug seems to have a
special affinity for the lymphatic system; its phy-
siological action is not thoroughly understood, but
provings and clinical experiences point to the glands
of the body as the organs primarily affected.

Brain and Spinal Cord. — It produces a brain fag,
frontal headache, with heaviness of the head, worse
from reading or writing; it produces chorea, with
one-sided movement ; and it produces epilepsy, with
aura running downward.

Mind. — Forgetfulness ; probably one of the most
effective remedies for this difficulty ; the patient mis-

AND THEIR TREATMENT, 283

places words (compare Agaricus and Arnica) ; fears
she will lose her reason ; that misfortune is impend-
ing ; that people will observe her confusion of mind ;
peevishness ; anxiety and shrinking on the approach
of evening; much mental trouble about imaginary-
things.

Sleep. — Awakes too early, three a. m.; sleepiness
during the daytime ; dreams of falling.

Accompaniments, — The menses appear a few days
before the proper time, and the flow of blood is often
considerable; sensation as if feet and legs were in-
cased in damp stockings ; the patient is pale, weak,
poorly nourished, and imperfectly developed.

Special Sphere of Action, — The various salts of
lime are useful in combating unfortunate constitu-
tional tendencies which are present in the human
race, whether sane or insane. Cases of defective
growlh, either physical or mental, are often im-
proved by the use of Calcarea. It is useful when
there is defective bony development, and also when
there is emaciation due to constitutional causes. In
glandular troubles with lymphatic swellings, it is
efiicacious in affording relief. The Calcarea patient
is of light complexion, of scrofulous appearance, in-
clined to lay on flabby fat, has a large abdomen, a
bulging forehead, and a small neck ; the patient is
disposed to sweat a good deal about the head, and is
troubled with cold feet. Calcarea patients are apt
to be apprehensive at times, and to fear that they
will go ** crazy ;" but generally a sluggish and apa-
thetic mental state is present. It is especially
adapted to cases of mild but sluggish melancholia in
fat, flabby, non-energetic and pot-bellied persons.

284 MENTAL DISEASES

CALCAREA PHOSPHORICUM

General Action. — Similar to the carbonate of lime.

Brain and Spinal Cord, — Cerebral anemia; ver-
tigo, \vorse on rising ; trembling of the limbs.

Mind. — Forgetfiilness of what has been done a
few moments before; writes wrong words, and the
same word twice or more times; wishes to be at
home although he is at home ; general failure of the
mental powers.

Sleep. — Drowsiness all day, yawning and stretch-
ing ; dreams of past experiences during the night.

Accompaniments. — Pale and flabby conditions,
with cold and blue extremities; imperfect circula-
tion ; general sluggishness of all the bodily fimctions.

Special Sphere of Action. — Dementia, especially of
young persons and those addicted to masturbation,
or those who have exhausted themselves from mas-
turbation ; senile dementia, loss of memory from old
age, or from cerebral disease.

CAMPHOR

General Action. — It acts upon the cerebrospinal
system, depressing the motor and intellectual centers.

Brain and Spinal Cord. — It produces vertigo and
heaviness of the head, constriction of the brain, with
throbbing in the cerebrum. Mentally, there is anx-
iety and extreme restlessness, and a sense of intoler-
able prostration; from this prostration the mind
sometimes rises to great maniacal excitement, some-
what similar to that produced by Veratrum Album.

Accompaniments. — Icy coldness of the whole
body ; clammy and exhausting sweats ; cramps, par-

AND THEIR TREATMENT, 285

ticularly of the lower limbs ; all symptoms are ag-
gravated at night, from motion and from cold.

Special Sphere of Action. — Exhaustion and col-
lapse from mania, from epilepsy, or from melancholia
with excitement.

CANNABIS INDICA

General Action, — It acts upon the cerebrospinal
system, producing various eflFects; sometimes it
causes a mild exhilaration, and again it stimulates
the prover to intense and exalted ecstacy; it pro-
duces decicjed eflFects upon the psychical system, and
stirs the mind to a wonderfiil variety of action. In
this respect it somewhat resembles Opium, Agaricus,
Belladonna, and Alcohol.

Brain and SpinalCord, — Pleasurable intoxication,
with bright, shining eyes ; heaviness of the arms and
legs, making it difficult to move or exercise ; a sensa-
tion as if the head were opening and shutting along
the vertex.

Mind. — Numerous hallucinations and illusions ;
sensations and motions are greatly exaggerated;
time and space seem immeasurable; a few seconds
seem to be ages or cycles of time ; a few rods seem an
immense distance ; the patient is unable to recall any
thought or event of the past on account of the multi-
tude of images which at present crowd upon the
brain; great mental exaltation, with singing and
laughing ; but this exaltation is followed by sadness,
depression and weakness; the natural tendency of
the individual is exaggerated under the influence of
Cannabis Indica; the mild and gentle person be-
comes more pleasant, happy and agreeable than
common, while those possessing irritable disposi-

286 MENTAL DISEASES

tions become exceedingly vicious and violent under
this drug.

Sleep. — Excessive sleepiness; voluptuous dreams
in which are realized the prophesies and promises of
Mahomet's heaven for the time being; but morning
discovers to the tired dreamer only profuse seminal
emission. Dreams of anger, of dead bodies, and of
horrible objects ; intense nightmare.

Accompaniments. — Frequent micturition, with
much burning in the urethra; urine starts slowly
and dribbles in a feeble stream ; sexual desires greatly
increased ; violent erections when walking, or riding,
or sitting still, and without amorous thoughts, ex-
cept during the dreams.

Special Sphere of Action. — Nervous diseases, with
delusions relating to time and space, accompanied
by unusual sexual disturbances, followed by weak-
ness of mind, tremulousness and exhaustion of body.
It may be useful in relieving the symptoms of general
paresis and catalepsy. The cataleptic state may
sometimes be induced by an overpowering belief in
the patient's mind that time and space are too vast
for change, hence a disinclination to make eflFort.

CANTHARIS

General Action. — This drug acts upon the cerebro-
spinal system, and it affects the genito-urinary tract
most positively.

Brain and Spinal Cord. — Cerebral congestions;
convulsions resembling hydrophobia, which are pro-
duced or aggravated by the sight or sound of water.
Hughes denies this symptom, but we have observed
some Cantharis cases that were much disturbed by
seeing water, or any bright, glistening substance.
(Also Stramonium).

AND THEIR TREATMENT, 287

Mind. — Sudden loss of memory ; furious delirium ;
barking like a dog; paroxysms of rage excited by
any bright, dazzling object ; amorous frenzy ; intoler-
able sexual desire ; mania, ivith a tendency to s^wear
(also Anacardium); violent, contradictory moods;
restlessness, culminating in attacks of rage; great
activity and sensitiveness of the mind.

Sleep, — Sleeplessness ; light sleep with anxious
dreams; erections during sleep (also Cannabis In-
dica), followed by wakefulness and anxiety.

Accompaniments. — Intense burning and smarting
pains along the urethra; spasmodic pains in the
region of the bladder; paroxysmal pains in both
kidneys ; the back in the region of the kidneys is sen-
sitive to touch ; constant urging to urinate ; painful
evacuation, drop by drop, of bloody urine, or pure
blood; sharp, burning pains in the genital organs,
accompanied by erections and fierce desire for sexual
intercourse.

Special Sphere of Action. — Cantharis is usefid
among the insane when the female patient suffers
with an intense nymphomania, or the male is af-
flicted with satyriasis. There is usually an inflam-
matory condition in some portion of the genito-urin-
ary tract which so excites the sexual desire that the
patient loses entirely his self-control, and resorts to
the most debasing practices, in order to gratify his
insane sexual impulses. The patient has at times a
furious delirium, during which he will cry, or bark
like a dog, and at times he will manifest great excite-
ment at the sight of water. This latter symptom is
suggestive of the conditions present in hydrophobia.
(Picric Acid is similar in its action to Cantharis, and
in large doses it produces an almost uncontrollable
sexual excitement. It is a valuable remedy when

288 MENTAL DISEASES

sexual excesses have produced exhaustion of the
vital forces and a condition of neurasthenia prevails.
It is also usefal in melancholia with indiflference^
want of will power, and abject despair. Even in
acute dementia with utter exhaustion it is a rival of
Phosphoric Acid. There is burning along the spine,
weakness of the legs and back, severe pains in the
back and occiput, going up to the supraorbital
notch. The least exertion causes prostration. In
such cases it has proved of striking benefit among
the insane).

CAUSTICUM

General Action. — Causticum depresses the ftmc-
tion of the motor nerves, especially those which take
their origin from neuclei in the medulla oblongata.

Brain and Spinal Cord, — Vertigo, with a tendency
to fall either forward or to the side ; brought on by
motion, or looking steadily at any object. Paralysis
of the recti muscles, or of the muscles of the face,
tongue, throat, or, more rarely, of the bladder and
extremities.

Mind, — ^Timid, uneasy, fretful ; disinclined to work,,
and cannot fix the attention upon any task; the
patient is sallow and sickly in appearance ; is appre-
hensive and despondent ; distrustful, and as is often
the case with an invalid, self-control is partially lost,
and he is inclined to break into peevish periods of
impotent anger.

Sleep, — Restless; the limbs twitch and jerk, but
writhout interrupting sleep.

Accompaniments, — Weakness of the vocal cords,
with catarrhal inflammation of the larynx ; hoarse-
ness worse in the morning ; painfiil cough with diffi-
cult expectoration of soapy tasting mucus ; stiffiiess

AND THEIR TREATMENT, 289

of the joints; contraction of the adjacent tendons
brought on and aggravated by exposure to cold.

Special Sphere of Action, — Causticum is especially
indicated in partial paralysis of the muscles supplied
by a single nerve, though it is sometimes prescribed
with benefit for the paralysis following cerebral
apoplexy; in either case accompanied by irritable
mental weakness and indecision. It is a remedy for
the constitutionally timid, and for anemic persons of
scrofalous habit.

CHAMOMILLA

General Action. — It acts on the cerebrospinal ner-
vous system, with characteristic affections of the
emotional sphere.

Brain and Spinal Cord. — Violent, constricting,
pressing, boring headache ; pressure from the vertex
extending over the forehead and temples ; congestion
of the brain following fits of anger (also Bryonia) ;
stiffness of the cervical muscles ; drawing pains in the
scapulae; pain in the back extending through the
abdomen to the front, and into the genitals ; severe
pain in the loins and hip joints.

Mind. — Irritable, impatient, peevish and snap-
pish; extreme sensitiveness to external impressions
(also Coffea, Ignatia, Belladonna and Staphisagria) ;
imagines he hears voices of absent friends at night ;
bad effects of anger; the patient is extremely cross
and sensitive (Nux Vomica is cross, but not so sensi-
tive as Chamomilla).

Sleep. — Sleeplessness from pain, and from ill-
temper; even while sleeping the patient moans,
weeps, wails, and starts suddenly ; on falling asleep
is tormented by anxious and frightfal dreams.

Accompaniments. — Sharp toothache ; griping

290 MENTAL DISEASES

colic, Tvith flatulence ; severe pains across the abdo-
men, followed by bilious diarrhea, and acrid dis-
charges from the vagina.

Special Sphere of Action. — Chamomilla is usefiil in
conditions of excessive hyperesthesia, and this over-
sensitiveness is accompanied by a corresponding
mental state which has been well described as one of
** snappish irritability." The patient is cross, im-
patient, and irritable. Nothing suits him; he is
angry, and cannot endure being spoken to, and will
not reply respectfully or even decently to any one
who addresses him. (Compare Antimonium Tar-
trate). The patient cannot bear pain, and makes
excessive complaint because of slight ailments. This
remedy is frequently prescribed for these symptoms
among the insane, and is of great service in aflfording
relief to the oversensitive. It relieves the sleepless-
ness of those who lie awake on account of severe pain,
such as neuralgia aflfecting a single nerve, or a small
group of nerves. Such patients are exceedingly cross
and irritable, and indulge in frequent jerkings of the
limbs, and twitchings of groups of muscles. It is a
remedy that has acquired much fame on account of
its success in relieving the sleeplessness of children,
and of weak and nervous women.

CHINA

General Action. — China acts upon the ganglionic
nervous system, and hence it aflfects especially the
ftinctions of vegetative life. China changes both the
quantity and the quality of the blood. Under its
influence the blood becomes more fluid than normal ;
the circulation becomes impaired, and we have gen-
eral debility and erethism, followed by chills, fever,
sweat, and finally hemorrhages. China produces

AND THEIR TREATMENT. 291

congestion of the liver, obstructing the function of
that organ; it produces excessive sensitiveness of the
entire nervous system.

Brain and Spinal Cord. — Intense congestion of the
brain; intense throbbing headache ; vertigo; ringing
in the ears ; deafness ; blindness. With the dizziness
there is a feeling as if the head would burst. This
feeling is worse from motion or sudden anger ; insup-
portable pain in small of back, like a cramp, worse
from least movement.

Mind. — Chooses wrong words, and makes feeble
and senseless expressions. The patient cherishes a
fixed idea that he is unhappy, and that he is perse-
cuted by his enemies ; feels impelled to jump out of
bed ; wants to destroy himself, but lacks courage ; is
low-spirited, gloomy, and has no desire to live;
cherishes an uncontrollable anxiety ; and, above all,
is stubborn and disobedient. Patients are sometimes
sent to insane asylums because they have been made
insane, in my opinion, not alone by the diseases from
which they suflfered, but also by a blind, reckless and
unwarrantable use of Cinchona, or its alkaloids,
given in overpowering and disastrous doses. Cin-
chona, if unwisely used, may become as dangerous
in its effects as the excessive use of alcoholic stimu-
lants.

Sleep. — Irresistible desire to sleep after eating;
constant yet unrefireshing sleep ; or at times sleepless
from ideas crowding too rapidly upon each other.
(Also Apis and Coffea). The patient is bent upon
making plans for the future, hence his sleep is short
and unrefreshing.

Accompaniments. — Loss of appetite; slow diges-
tion ; thin, watery, involuntary diarrhea ; weakness
and disability from long continued sickness, and

292 MENTAL DISEASES

from excessive losses of fluid from the body; fever
recurring at somewhat regular intervals.

Special Sphere of Action, — Melancholia and sub-
acute mania when there are general anemia, pro-
found debility, and tendency to periodical aggrava-
tion of all the symptoms.

CICUTA VIROSA

General Action, — This drug is a cerebro spinal
irritant, producing epileptiform convulsions, tetanus,
and generally tonic and clonic spasms.

Brain and Spinal Cord. — Severe occipital head-
ache ; vertigo, with opisthotonos.

Mind, — Dull and stupid, or the patient indulges in
weeping and howling; sometimes great mental ex-
citement exists, and the patient sings, shouts, and
dances.

Accompaniments, — Grinding of teeth ; swelling of
tongue; difficulty in speech; involuntary twitching
of muscles in the arms and fingers (also Cuprum).

Special Sphere of Action, — Mental depression and
anxiety, accompanied by vertigo, after traumatism ;
general paralysis, with spasmodic twitchings ; some-
times loss of consciousness; mental anxiety, with
violent hiccough. Cicuta is one of the most effective
remedies for persistent hiccoughing known in the
Materia Medica.

CIMICIFUGA (AcTEA Racemosa)

General Action, — It produces cerebral and spinal
hyperemia, with irregularity of motion, and great
w^eakness and tremulousness of the extremities.

Brain and Spinal Cord, — Headache throughout
the whole brain, with sense of soreness in the occi-

AND THEIR TREATMENT, 293

pital region ; vertigo ; brain feels too heavy and too
large for the cranium ; the top of the head feels as if
it would fly Q&.

Mind. — Great melancholy, with sleeplessness, fol-
lowed sometimes by transient exhilaration ; halluci-
nations of sight, sees rats, sheep, etc.; sensation as
if a heavy black cloud had settled over her, and en-
veloped her head, so that all was darkness and con-
fusion ; at the same time there seems to be a weight
like lead upon the heart ; suspicious, indifferent ; taci-
turn; takes no interest in household matters (also
Sepia).

Sleep. — Sleeplessness from nervous irritation ;
sleeplessness, with great depression and despair.

Accompaniments. — ^There is a general rheumatic
diathesis; severe cutting pains in the joints and in
the back ; in women there is with the mental depres-
sion a sense of weight and bearing down in the
uterine region (also Belladonna), with a feeling of
heaviness and torpor in the lower extremities; re-
tarded menstruation ; suppression of menses from a
cold, with rheumatic pains in the head, extending
down to the neck and back; tremulousness of the
muscles throughout the body.

Special Sphere of Action. — Mental depression as-
sociated with uterine diseases ; mental depresion ac-
companied by rheumatic pains; mental depression
and tremulousness, following overwork and active
dissipation ; delirium tremens ; bad effects of opium.
It is indicated in general paresis when the patient is
weak and exceedingly tremulous throughout the
whole body, and particularly in the melancholic
stage of the disease.

294 MENTAL DISEASES

COCCULUS

General Action. — On the motor traxit of the cere-
brospinal axis, and especially on the cerebellum, pro-
ducing fulness of the head, and a swaying of the
body in a semicircular direction, with loss of power
in the lower limbs.

Brain and Spinal Cord. — Vertigo, with inclination
to vomit ; sensation as if the head were swollen ;
headache in the occiput and nape of neck ; sensation
as if the back of head were opening and shutting like
a door ; headache aggravated by riding in a wagon ;
paralytic weakness of the back and legs, and a feel-
ing as if the soles of the feet were asleep.

Mind. — Vacillating ; cannot accomplish any
work; slowness of apprehension; time passes too
quickly (too slowly. Cannabis Indica); sobbing,
moaning and groaning; thoughts continue upon
some one unpleasant subject; depressed; easily of-
fended; every trifle makes him angry; a delusion
that his organs are hollow ; sometimes this delusion
relates to the head, or the chest, or the abdomen.

Sleep. — Sleeplessness from night-watching (Colchi-
cum) ; sleep aggravates all the symptoms (Lachesis).

Accompaniments. — Physical and mental sjrmp-
toms aggravated by eating or drinking; intense
nausea ; an inclination to vomit while riding in a
carriage or a boat; great distension of the abdo-
men, with colic; in a female, cramping pains in the
uterus and ovaries, with nausea and headache ; vio-
lent spasmodic pains during the menstrual flux, after
mortification or disappointment.

Special Sphere of Action.— Diseases accompanied
by intense vertigo, relieved by lying down ; diseases

AND THEIR TREATMENT, 295

caused by overexertion, overstudy, overdrinking,
the motion of travel ; uterine disorders at the change
of life; victims of masturbation; victims of excessive
ambition who have been disappointed, snubbed, and
angered by those around them. (For dissipation
and disappointment we also think of Nux Vomica, of
Gelsemium, and of Ignatia).

COFFEA CRUDA

General Action, — Acts upon the cerebrospinal
system, causing an increased susceptibility to ex-
ternal impressions — that is, a general hyperesthesia
of the nervous system.

Brain and Spinal Cord. — Headache from think-
ing ; headache as if the head were torn or dashed to
pieces; headache as if a nail were driven into the
head (also Hepar Sulphur and Ignatia) ; a CoflFea
headache, like Nux Vomica, is worse after eating.

Mind, — Ecstasy ; fiiU of ideas ; quick to act ; great
mental restlessness ; all the senses under Coffea are
stirred to acute and rapid action ; under its primary
and secondary influences the mind oscillates between
the heights of ecstatic and sensitive joy, and the
depths of gloomiest and most dismal despair.

Sleep, — Sleeplessness because mind is very active
(also China), and because the emotions have been
driven by pleasant occurrences into a state of ex-
cessive excitement.

Accompaniments. — General acuteness of the sen-
ses; distressing and insupportable pains, particu-
lary neuralgia of the right side of the face and head ;
an aversion to the open air because it seems to ag-
gravate the pain.

Special Sphere of Action, — Melancholia with ex-
citement and sleeplessness ; hysterical aflfections pro-
duced by excessive pleasurable emotions.

296 MENTAL DISEASES

COLCHICUM

General Action, — It acts upon the processes of
nutrition; increases the secretions generally, and
especially the quantity of urea and uric acid elimi-
nated. In poisonous doses it is an irritant to the
alimentary tract, and causes death by collapse and
paralysis of respiration.

Brain and Spinal Cord. — Boring headache over
the eyes ; pressure, especially in the occiput ; para-
lytic sensations and numbness of the hands and feet.

Mind, — Sensitive to external impressions, espe-
cially bright lights and strong odors; memory
weak ; intellect clouded ; the patient is peevish, fret-
fill, and never satisfied.

Sleep. — Sleeplessness after night- watching or
studying at night ; awakened fi-om sleep by dreadfiil
dreams.

Accompaniments, — Great thirst, but no appetite;
aversion to food, and especially to the smell of food ;
great distension of the abdomen, with colicky pains ;
dark and scanty urine; rheumatism, accompanied
by great exhaustion, and by weakness of both body
and mind. The pains are all of a boring nature.

Special Sphere of Action. — It acts well in patients
who are depressed and irritable, and who are of a
rheumatic or gouty diathesis.

COLOCYNTH

General Action. — This drug acts upon the gangli-
onic nervous system, more particularly upon the
solar plexus, the lumbar and the femoral nerves, and
the tissues which these nerves supply.

Brain and Spinal Cord. — Pressive frontal head-

AND THEIR TREATMENT, 297

ax:lie, tearing and digging through the whole brain ;
sharp, cutting pains along the tracts of the main
nerves leading from the brain ; cramping pains in the
lumbar region, extending down to the legs, espe-
cially along the course of the sciatic nerve.

Mind. — Extremely irritable and easily angered;
impatient and morose. In mental irritability, Co-
locynth imitates Chamomilla and Nux Vomica.

Sleep. — Sleeplessness on account of acute cramp-
ing pains ; inclined to sleep as soon as the pains pass
aw^ay.

Accompaniments. — Sharp, colicky pains in the ab-
domen, doubling the victim up like a jack-knife;
diarrhea watery, yellow, frothy, and accompanied
by much flatulence.

Special Sphere of Action. — Persons of nervo-bilious
temperament, and those suffering from severe cramp-
ing and neuralgic pains, and from the effects of
sudden outbursts of anger (Bryonia).

CONIUM MACULATUM

General Action. — Its effects are especially notice-
able upon the motor nervous tract; it produces
paralysis from the feet up. One of the best provings
of hemlock may be found in the death of Socrates.

Brain and Spinal Cord. — Intense vertigo, worse
on lying down ; headache as if the head would burst ;
pain in the occiput, and at each heart beat the brain
at the base feels as if stabbed with a sharp knife;
trembling of limbs; sensation of weakness in the
back and limbs ; sense of exhaustion as if paralyzed.

Mind. — ^Loss of memory; inability to make any
mental effort.

Sleep. — Unrefreshing, and disturbed by frightful

dreams.
20

298 MENTAL DISEASES

Accompaniments. — Palpitation of the heart ; vio-
lent, spasmodic, dry cough; sexual desire without
erection.

Special Sphere of Action. — Senile dementia; mental
weakness ; loss of memory ; peevishness ; vertigo. It
is useful when persons suflfer from the ill eflFects of
ungratified sexual desire ; it is therefore useful in re-
lieving the ailments of old maids, of widows, of
widowers, of old people generally, and of those who
have a tendency to paralysis, especially in the lower
limbs; likewise for children who appear to be pre-
maturely old.

CUPRUM METALLICUM

General Action. — In massive doses it produces
nausea, purging, and collapse. Its action upon the
nervous system, detailed below, is secondary, and
follows its continued administration in sinaller
quantities.

Brain and Spinal Cord. — Irritation of the cerebro-
spinal axis, with painful spasmodic contractions of
the abdominal muscles, and those of the lower ex-
tremities; or clonic convulsions not limited to any
single part, accompanied by loss of consciousness,
and followed by a deep sleep.

Mind. — Violent ; delirium, with great fear ; shrinks
from any one who approaches (also Stramonium) ;
or bites, strikes, and tears to pieces everything within
reach, as does Belladonna. In lesser degree there may
be restlessness and melancholy, with a constant sense
of approaching misfortune.

Sleep. — ^Very heavy ; almost a comatose condition,
or intensely sleepy, and unable to rest.

Accompaniments. — Spasmodic attacks of dysp-
nea; chest feels contracted, almost to suflFocation;

AND THEIR TREATMENT, 299

ineflfectual eflForts to vomit, with contraxitive pains in
the stomach at intervals.

Special Sphere of Action. — In some cases of idio-
pathic epilepsy it has seemed to be of service, but is
most useful in the spasmodic cramps in weak, nerv-
ous individuals; those in whom mental or physical
overwork has advanced to complete exhaustion.
Reaction is deficient, and relapse follows the slightest
indiscretion, until Cuprum starts the patient on the
way to recovery.

DIGITALIS

General Action. — Acts upon the cerebrospinal sys-
tem, especially affecting the cardiac branch of the
pneumogastric nerve. The first effect upon the heart
is to strengthen the contractions and diminish the
number of heart beats; the force of these contrac-
tions being increased, exhaustion soon follows ; then
the number of beats becomes greatly increased, with
a marked decrease in their strength; this loss of
strength may continue until paralysis results.

Brain and Spinal Cord. — Headache, with conges-
tion ; marked pulsations in the forehead (Cactus has
pulsations in the top of the head); heavy, paralyzed
feelings in the legs.

Mind. — Anxiety, and fear of the future; low
spirits, w^ith inclination to weep ; the eyes seem con-
stantly floating in tears ; anxiety as from a troubled
conscience; fear of death; fear that the heart will
stop beating.

Sleep. — Uneasy, unrefreshing sleep ; frequently
startled, and awakes easily many times during the
night (also Phosphorus).

Accompaniments. — Constant urging to urinate;
the urine is scanty, coffee-colored, and has a brick-

300 MENTAL DISEASES

dust sediment (also Lycopodium); extremely weak
and rapid palse, or a slow, full, sluggish pulse.

Special Sphere of Action. — Melancholia following
masturbation; mental depression in cases of heart
disease; insanity when the circulation is weak and
greatly disturbed.

FERRUM METALLICUM

General Action.— This drug produces marked
changes in the condition of the blood ; under its in-
fluence the number of red corpuscles is diminished;
the watery portions of the blood are increased, while
the albumen is decreased ; it produces a condition
which Dr. S. Weir Mitchell has described as "fat
anemia.*' The patients are weak, pale, and anemic,
yet an appearance of flabby fiilness sometimes re-
mains.

Brain and Spinal Cord. — Congestions of the brain,
with sense of fiilness, and throbbing pains in the
head (also Glonoin); worse after midnight; a feeling
of paralysis in the lower limbs.

Mind. — Muddled and confiised; depression of
spirits in Tvomen, especially at the menstrual period ;
anxiety and peevishness ; the slightest contradiction
angers (also Chamomilla).

Sfeep.— Sleepy, but unable to sleep (also Bella-
donna and Gelsemium) ; feels sleepy usually as a re-
sult of debility ; wakens frequently during the night
(also Phosphorus), and feels weary, prostrated and
unrefireshed in the morning (also Nux Vomica).

Accompaniments. — General weakness and prostra-
tion ; face pale, but flushes easily ; sometimes there is
emaciation, at other times the fat remains, but in all
cases there is great weakness; peculiar pallor of
the countenance; menses too early and too pro-

AND THEIR TREATMENT, 301

fiise ; diarrhea of hot, undigested stools ; while the
patient is pale when quiet, the least excitement or
motion produces rosy cheeks.

Special Sphere of Action. — Hypochondriacal mel-
ancholia ; weak and chlorotic women ; children w^ho
are badly nourished, and prone to diarrhea. The
form of iron from which we have obtained the best
results has been the citrate.

GELSEMIUM

General Action. — It paralyzes the respiratory
center in the medulla, and the motor nerves gener-
ally, especially those of the eye. Under its influence
there is a passive venous congestion.

Brain and Spinal Cord. — Passive venous conges-
tion of the cerebrum; brain feels bruised; great
heaviness of the head ; dull, dragging pains in the
occiput; scalp feels sore (also Arnica, Bryonia and
Nux Vomica) ; giddiness ; drawing, contracting pains
in the calves of the legs ; paralysis of the muscles of
motion.

Mind. — Dull and stupid; the victim feels as if
grossly intoxicated ; unable to think or fix the atten-
tion ; fear of death, with moderate anxiety concern-
ing the present.

Sleep. — ^Drowsy, but cannot sleep; as soon as he
falls asleep he becomes delirious and mutters while
dreaming (also Cactus) ; sleeplessness, with a wide-
awake but helpless feeling.

Accompaniments. — Prostration of the whole mus-
cular system; shooting, tearing, neuralgic pains
along the tracts of the large nerves ; rapid and irreg-
tdar action of the heart ; chilliness, followed by fever
and stupidity.

302 MENTAL DISEASES

Special Svhere of Action, — Mental depression re-
sulting from fright, from bad or exciting news, or
from anticipation of coming trouble, as when a stu-
dent contemplates the horrors of final examination.
Neuralgia; convulsions; paralysis; epilepsy; hys-
teria; rheumatic congestions; dysmenorrhea; and
cerebrospinal meningitis. Gelsemium is especially ap-
plicable to young and nervous people. It relieves
sleeplessness in recent or incipient drunkards; in
brain workers, in business men, and in those who
have become suddenly exhausted by work or w^orry,
or both. The Gelsemium patients present a heavy
and besotted appearance. They are dull and stupid,
and seem to be on the verge of heavy slumber, yet
cannot sleep.

GLONOIN

General Action, — It dilates the arterial system, in-
creases the fulness and rapidity of the pulse, and
produces accelerated respiration, paralysis, loss of
reflex action and sensation, and death from stop-
page of respiration.

Brain and Spinal Cord. — Head feels full to burst-
ing, with violent throbbing, usually without severe
pain, except when shaking the head; with slight
motion sharp violent pains shoot through the brain
(also Bryonia) ; the skull seems too small, and feels
as if it would burst with every beat of the heart.

Mind. — Ideas become confused; loses his way on
familiar streets; does not recognize them; falls
down, with loss of consciousness.

Sleep. — Restless sleep, with confused dreams, yet
diflScult to awaken.

Accompaniments. — The whole action of Glonoin
centers about its power to produce sudden and vio-

AND THEIR TREATMENT, 303

lent changes in the circulation. It is characterized
by a full strong pulse ; the arteries throbbing visibly
as under Belladonna; and active congestions are
seen in the hot, bright red skin which almost imme-
diately follows its administration.

Special Sphere of Action. — ^This remedy fits very
closely and successfiiUy relieves the symptoms most
characteristic of insanity foUowng sunstroke ; name-
ly, confusion of mind, and incapacity for exer-
tion, often with short outbreaks of frantic maniacal
agitation. It is also useful in analagous symptoms
arising from traumatism, and in the after effects of
fright, fear, and mental excitement.

HELLEBORUS NIGER

General Action. — It is a pow^erful gastro-intestinal
irritant, producing violent vomiting, purgmg, pain
in the abdomen, collapse, stupefaction and convul-
sions. It retards respiration, and paralyzes the
heart.

Brain and Spinal Cord. — ^RoUs the head night and
day; bores it into the pillow; dulness and heavi-
ness in the head; head hot and heavy; the patient
lies in a stupefied condition; lack of muscular co-
ordination ; awkward ; objects fall from the hands
(also Apis Mellifica).

Mind. — Depressed ; thinks himself very unhappy ;
obtuseness of the senses and mental faculties; is
stubbornly silent; indiflFerent to pleasure or pain;
has difficulty in collecting the thoughts, and an ab-
sence of desire for action ; homesickness.

Sleep. — Drowsy; sleeps heavily; interrupted by
shrieks, and muscular twitchings ; confused dreams.

Accompaniments. — Dropsical effusions into the
serous cavities in the brain, chest or abdomen. Face

304 MENTAL DISEASES

bloated and distorted ; urine scanty, hot and turbid ;
constant chewing motion of the jaws.

Special Sphere of Actiofl.— Hellebore has always
been a prominent remedy in the treatment of the
various forms of meningitis. In certain apathetic
melancholias, with sluggish circulation and passive
cerebral congestion, it relieves the symptoms above
detailed.

HEPAR SULPHUR

General Action. — ^This drug produces enlargement
and suppuration of the lymphatic glands, an un-
healthy skin, ulcers, eczematous eruptions, and ca-
tarrhal conditions of the mucous membranes.

Brain and Spinal Cord. — Pain on one side of the
head as if a plug or dull nail were driven into the
brain (Ignatia and Coffea); a sense of swashing in
the brain.

Mind. - Low-spirited and irritable ; memory
weak; he forgets words and places; dwells on
former unpleasant incidents which make him feel
discouraged (also Natrum Muriaticum); is even sui«
cidal. The anxiety is greatest in the evening.

Sleep. — ^Violent starts when falling asleep; excess-
of thoughts keep him awake in the latter half of the
night.

Accompaniments. — Profuse mucous secretions,
with sharp splinter-like pains ; great sensitiveness of
all aflfected parts; cannot bear any pressure. The
symptoms are all better with warmth, and made
worse by exposure to cold.

Special Sphere of Action. — Hepar Sulphur is one of
the remedies less used among the insane for the direct
control of mental symptoms than for the improve-
ment of their physical state. Many other remedies

AND THEIR TREATMENT, 305

have similar symptoms, but none other takes its
place in the management and prevention of suppu-
rative processes. It is also particularly indicated in
the atonic dyspepsias, with a craving for stimulants
and condiments.

HYOSCYAMUS

General Action, — It produces special effects upon
the sensorium, causing hallucinations of sight, and
great mental activity. In larger doses, it produces a
temporary paralysis of the voluntary muscles, with
partial obliteration of consciousness.

Brain and Spinal Cord. — Cerebral congestion of a
milder type than that produced by Belladonna;
trembling ot the limbs ; spasmodic twitchings of the
muscles of the back, and in the organs of locomo-
tion.

Mind. — Delirium, accompanied by periods of
stupor; thinks he is in the wrong place; foolish
laughter; almost always jolly; talks in a hurried
and cheerful manner ; intensely jealous ; at times las-
civious; inclined to uncover the body and expose
the sexual organs; sings amorous and obscene
songs.

Sleep. — Sleeplessness from excessive mental excite-
ment (also Bryonia and Coffea); sleepless without
any apparent cause ; dreams of obscene things ; has
dreams of a terrifying nature, and awakens with a
loud scream.

Accompaniments. — Retention of urine (also Can«
tharis and Arsenicum); sometimes has involuntary
discharges of urine (also Causticum); attacks of hic-
cough (also Ignatia and Cicuta Virosa); spasmodic
twitchings in various muscles; tendency to convul-
sions; dry and spasmodic cough; involuntary
stools.

306 MENTAL DISEASES

Special Sphere of Action.— It is especially adapted
to women who become insane during pregnancy or
after parturition ; to those who suffer from jealousy
or unhappy love ; to victims of delirium tremens ;
and to young people and children who are inclined
to convulsive attacks, to epilepsy, and to chorea. In
general paresis it is frequently called for to control
the delusions. This drug has been famous as a sleep
producer for many years. Hyoscyamine and Hyos-
cine, the active principles of the original drug, have
been much experimented with, and perhaps have
been used in too large and too frequently repeated
doses to secure the best and most satifactory results.
The Hyoscyamus patient is sleepless without appar-
ent cause, save that the nervous system has become
somewhat depleted, while at the same time the mind
of the patient has been overworn by too long con-
tinued or too active use. The Hyoscyamus patient
has neither the anxiety of Aconite, the rage of Bella-
donna, nor the stupidity of Gelsemium, but he dis-
plays the individual characteristic of a jolly and
wakefiil delirium. Hyoscyamus paints the mental
town of its victim a brilliant and luminous red, and
stimulates him to sing, in merriest and most vocifer-
ous tones, the songs of Venus and Bacchus com-
bined.

HYPERICUM

General Action, — It acts upon the cerebrospinal
system, producing cerebral and spinal hyperemia,
with great sensitivess of the nerves.

Brain and Spinal Cord. — Headache; confusion;
vertigo and heaviness; congestion of the spinal
cord ; convulsions from a blow^ on the head.

Mind. — Irritable ; inclined to speak sharply ; sees

AND THEIR TREATMENT. 307

spirits and specters ; suffers from loss of memory ;
intense depression after nerve injuries.

Sleep, — Spasmodic jerkings of the limbs on going
to sleep ; dreams of traveling.

Accompaniments. — Tympanitic distention of the
abdomen; great sensitiveness to external impres-
sions.

Special Sphere of Action. — Mental depression fol-
lowing all nerve injuries; convulsions, spinal aflfec-
tions and lock-jaw following wounds of the nerves:
Hypericum is said to be the Arnica of the nervous
system, and in some cases this drug has seemed to
have the power of arresting nerve degeneration,
notably in one case of progressive muscular atrophy.

IGNATIA

General Action. — It acts upon the cerebrospinal
nervous system, more especially on the spine, pro-
ducing hyperesthesia of all the senses.

Brain and Spinal Cord. — Congestive headache,
following anger or grief, especially grief; headache,
with bruised feeling, or a sensation as if a nail were
driven in the temples ; occipital headache, better from
pressure. Its effects upon the spine are shown by
the sudden jerkings of the limbs, by twitchings of
groups of muscles, by a feeling of heaviness in the
feet, with a sensation of burning in the soles of the
feet.

Mind. — Intense though partially suppressed grief;
anxiety as if crime had been committed ; grief fol-
lowing the loss of friends ; grief of children after be-
ing reproved or punished by parents; fearfulness;
irresoluteness ; timidity; sad, quiet, melancholy.
Sometimes the Ignatia case is hysterical and hilari-

308 MENTAL DISEASES

ous temporarily; but soon subsides, and "weeps
tears inwardly."

Sltep. — ^Very light sleep ; jerking of the limbs on
going to sleep ; dreams of one thing, particularly of
the object of aflFection.

Accompaniments. — Frequent sighing ; desire to
take a deep breath ; sensitive spine ; sharp, constrict-
ing pains in the anus ; constipation ; stools large and
soft, but passed with difficulty; spasmodic cough
from mental anxiety.

Special Sphere of Action, — Ignatia is a remedy of
great value in conditions of profound mental depres-
sion, and the cases of melancholia in which it does
not find a place during some period of their treat-
ment are very few. It is particularly useful in ail-
ments resulting from grief, the loss of friends, and
bad news of any sort; the eflfects ol disappointed
love; ailments of a nature which lead to concealment
rather than publicity, and over which the patient
broods in silence, with sad countenance, and frequent
sighing ; griefs and troubles about which the patient
can rarely be induced to talk, but from which he
suffers often to the extent of unhinging his reason,
and driving him to despair, and possibly to suicide.
It is curative in long continued but suppressed sad-
ness occasioned by family afflictions or by financial
misfortunes ; in chorea or epilepsy in children whose
troubles are occasioned by feeling that they have
been unkindly or harshly treated. In general paresis
it relieves when there is long continued depression of
mind with inclination to mourn and brood over the
past, while he also cherishes dark apprehensions
relative to the fiiture. The Ignatia patient not only
broods and mourns, but likewise has attacks of gen-
eral restlessness, when he wrings his hands and

AND THEIR TREATMENT, 309

trembles a good deal. It is useful in hysterical aflfec-
tions when there appears to be great sensitiveness
to external impressions, alternate laughing and cry-
ing, cold extremities, accompanied or followed by
the passage of large quantities of pale urine. (Also
Gelsemium and Phosphoric Acid). There is severe
pain in the head of the character known as clavus
hystericus. This remedy alone has proven curative
in numerous cases of melancholia, particularly for
women, where it seems to do better than for men.
With men, Arsenicum or Nux Vomica appears to act
better.

IODINE

General Action, — Its action through the sympa-
thetic nervous system is upon the glandular organs,
in the first instance stimulating their ftinctions, and
increasing their secretions ; and secondarily, produc-
ing atony and advanced or complete atrophy.

Brain and Spinal Cord. — Headache as if a band
were drawn tightly around the head; worse with
active exertion, as walking rapidly; sometimes a
feeling of paralytic weakness in the arms; vertigo on
the left side only.

Mind. — Restless ; constantly moving about ;
changes his seat frequently; over careful; fears an
unfavorable outcome to every little occurrence (com-
pare Calcarea Carbonica and Arsenicum); shrinking
and fear when any one comes near; low-spirited;
irritable and sensitive, especially during digestion.
The patient may feel that the brain is stirred up,
and that he must keep in constant motion, or go in-
sane.

Sleep. — Restless after midnight, with vivid, an'x-

aiO MENTAL DISEASES

ions dreams ; feels constantly as if she had forgotten
something.

Accompaniments. — Hoarseness or complete apho-
nia, with dry croupy congh or wheezing respira-
tion, pulmonary congestion ; chronic diarrhea, with
bloody mucous stools; enlargement of the thyroid
gland, especially if soft, with swelling of the other
glands of the neck.

Special Sphere of Action, — Iodine is most success-
ful in elderly persons, with dark hair and eyes, and
with a tendency to rapid emaciation. It is indicated
in the melancholia of the aged, and in those weak-
ened by the scrofulous diathesis, or succumbing to
cretinic conditions. Its remarkable power in resolv-
ing and dissipating morbid hypertrophies and cellu-
lar new growths renders it, especially in combina-
tion with Potassium, of prime service in the organic
insanities brought about by the lesions of tertiary
syphilis in the central nervous system.

LACHESIS

General Action. — This drug acts upon the blood,
and produces decomposition and defibrination of
that fluid; consequently Lachesis induces hemor-
rhages, abscesses, malignant inflammation, gan-
grene, and pyemia. Upon the nervous system it pro-
duces two characteristics : hyperesthesia and intoler-
ance to pressure in all parts of the body, and the ag-
gravation of all symptoms after sleep.

Brain and Spinal Cord. — Intense pressive head-
ache, extending from the frontal region to the base
of the brain and to the nose ; the headache is accom-
panied by nausea and vertigo on w^aking in the
morning; there is great weakness in the arms and
legs ; with the weakness and exhaustion there is sen-

AND THEIR TREATMENT, 311

sitiveness to all external impressions, and the slight-
est constriction around the neck or chest or waist is
unbearable.

Mind. — Mental activity, with a tendency to talk
much; yet the mind is weak and erratic, and the
victim makes many mistakes if he attempts any in-
tellectual work; lack of mental continuity; con-
stantly changing from one subject to another ; jeal-
ousy; hallucinations of frightful images. The La-^
chesis patient thinks himself under superhuman
control ; also thinks himself dead, and that prepa--
rations are being made for a gaudy funeral.

Sleep. — Wide awake in the evening ; restless sleep,
disturbed by dreams ; tossing about in sleep ; great
sleepiness, but unable to sleep (also Belladonna and
Chamomilla).

Accompaniments. — Dimness of vision, with black
spots before the eyes ; lefb-sided tonsillitis ; diflSiculty
in swallowing liquids ; sensitiveness of throat ; sen-
sitiveness of internal organs, as well as sensitiveness
upon the surface of the body; scanty and feeble
menses, with dark, bloody discharges ; extreme sen-
sitiveness of the uterus, particularly at the menstrual
flux and during the climacteric period ; general left-
sided pains, with great sensitiveness.

Special Sphere of Action. — It is particularly ser-
viceable in the mental depressions which sometimes
occur in women at the climactric period ; the patient
is often loquacious, and jumps from one subject to
another in conversation. It seems to be useful in
certain cases of neurasthenia, where it aids in arous-
ing the patient from an apathetic or indifferent con-
dition, and giving him his first start toward re-
covery. It is called for in insanity following fevers

312 MENTAL DISEASES

of a low type, and left-sided paralysis (also Arnica
and Lycopodium).

LILIUM TIGRINUM

General Action. — It acts upon the heart and
causes cardiac irritability, with palpitation. It also
produces venous congestions, most pronounced in
the female generative organs.

Brain and Spinal Cord. — Dull headache over the
left eye, or alternating from side to side ; fulness of
the head, as if its contents would be pushed out at
every aperture ; heat in the top of the head ; vertigo,
which is better in cool air ; the whole body feels sore
as if pounded (also Arnica and Eupatorium Per-
foliatum).

Mind. — Great fear, and dread of insanity (also
Sepia and Calcarea Carbonica) ; fear that should she
become insane no one would care for her; loss of
memory ; uses wrong words ; desire to do something
with hurried manner, but unable to accomplish any-
thing. Sometimes from depression and anxiety the
Lilium patients pass into a mental state where they
become peevish and fretful, and where they are in-
clined to curse and talk in an obscene manner.

Sleep. — Inability to sleep, worse before midnight ;
restless sleep, and wild feelings in the head ; frightful
dreams; everything seems hot, particularly in the
region of the genitals ; twitchings of the legs on fall-
ing asleep.

Accompaniments. — Menses too late and scanty;
bearing down in the uterine region, with a feeling as
if everything were coming out (also Sepia and Bella-
donna) ; ftinctional disease of the left ovary, accom-
panied by stinging, cutting, grasping pains; heart

AND THEIR TREATMENT, 313

feels as if squeezed by a vise, and as if the blood had
been all pressed out.

Special Sphere of Action, — Melancholia with ex-
citement, preceded by ovarian and uterine diseases,
and by functional disturbances of the heart ; mental
disturbances following subinvolution of the uterus ;
depression of mind after severe and exhausting
labors.

LYCOPODIUM

General Action. — ^This drug acts upon the vegeta-
tive system, producing weakness of its powers, and
wasting and decay of the tissues. It acts also upon
the liver and the digestive tract in such a way as to
cause hepatic congestions, constipation, indigestion,
and marked accumulations of flatulence.

Brain and Spinal Cord. — Pressing frontal head-
ache, especially right side of the head (Lachesis head-
ache is on the left side) ; the Lycopodium headache
is worse from 4 to 8 p. m.; pressive headache in the
vertex (Cactus has throbbing in the vertex) ; under
Lycopodium the hair becomes gray too early in life ;
it induces falling out of the hair and causes baldness;
burning pains between the scapulae; pain in the
small of the back ; drawing, tearing pains in all the
limbs ; stiffness and painfullness of the joints ; cramps
in the calves of the legs ; sensation as if a tight band
were bound around the body at the umbilicus ; sen-
sation of a band about the head (also Mercurius).

Mind, — Great depression of spirits ; very sad, de-
sponding and anxious ; doubts about salvation (also
Sulphur and Veratrum) ; weakness of memory, with
confusion of thoughts; when the digestive organs
are much disturbed, the patient is fretful, irritable

and morose, or he may become vehement and angry
21

314 MENTAL DISEASES

if crossed in his purpose or desires ; at times is im-
perious and domineering in manner; thinks himself
of much importance (also Belladonna, Cuprum, Pla-
tina, and Veratrum).

Sleep. — Sleepy during the daytime, wakeful at
night, sleep restless; cries and starts in sleep (also
Chamomilla and Antimonium Crudum); unrefresh-
ing sleep; feels blasS in the morning (also Nux
Vomica) .

Accompaniments. — Fulness and distention of the
abdomen, with flatulence; frequent eructations;
variable appetite ; considerable hunger, but a small
quantity of food produces sensations of fulness
(also Cinchona and Sepia) ; red sediment in the
urine (also Digitalis); general aggravation from 4
to 8 p. M.

Special Sphere of Action. — Melancholia, accom-
panied by dyspepsia, flatulence and constipation;
subacute mania, with indigestion, chronic hepatitis^
and catarrh of the bladder, and chronic rheumatism;
mental disturbance in the latter stages of phthisis
pulmonalis; emaciation from lack of pow^er to as-
similate food, and accompanied by night sweats.

MERCURIUS

General Action. — Acts upon the entire organism,
but especially upon the vegetative system, producing
depressions of functional power, and decomposing
and disintegrating the organic constituents of the
body; secretions and excretions are increased, but
the secretions become thinner than normal, and the
excretions become acrid and excoriating.

Brain and Spinal Cord. — Congestion of the brain,
with feeling of a band about the head (also Lycopo-
dium); the scalp is painfiil to the touch (also Nitric

AND THEIR TREATMENT, 316

Acid, China, Nux Vomica and Arnica); weakness
and trembling in the limbs and back, worse at
night ; cold extremities.

Mind. — Great weakness of memory ; loss of sense
of decency ; delusions concerning food ; eyes dull and
staring; under the influence of impaired vision he
becomes suspicious and distrustful of those about
him.

Shep. — Sleepy during the dajrtime, but sleepless
at night, because all pains in the Mercurius patient
are aggravated at night.

Accompaniments, — Pale face; swollen tongue and
gums; loss of teeth; profuse, watery discharges
from the mouth ; a sluggish condition of the abdom-
inal organs ; foul breath ; pain and soreness of all
the muscles; bone pains at night and in damp
weather.

Special Sphere of Action. — The various mercurial
preparations are frequently of use in the treatment
of demented or depressed conditions, following scrof-
ulous, syphilitic, rheumatic, and catarrhal affections.
The constitution seems to be deeply affected; the
blood is impoverished, and the body wastes. There is
frequently hectic fever; the skin ulcerates easily; the
patient is sleepless, and troubled with twitchings of
the Umbs and the characteristic Mercurial tremor. In
general paresis it is indicated when there is a general
heavy and soggy condition of the system; the
patient is inclined to be filthy in body and groveling
mentally, and inclined to rambling incoherence or
apathetic dementia. Experience seems to teach that
Mercurius acts better in acute cases when preceded
by a few doses of Aconite. It is a drug whose gen-
eral action covers those mental states which natu-
rally follow disorganization of the physical system

316 MENTAL DISEASES

by diseases which are the result of exposure to the
worst types of both weather and women.

NATRUM MURIATICUM

General Action. — It acts upon the vegetative sys-
tem, upon the blood, upon the digestive tract, and
upon the spleen. Normally, salt is present in every
tissue of the body, and this is not to be wondered
at, for we use it in almost every article of food.
When taken in excess it is highly irritative and dis-
organizing in its action, and leaves no organ unaf-
fected. Soldiers, sailors and Arctic explorers, and all
who are obliged to live upon very salt food, event-
ually have catarrhal discharges from all the mucous
surfaces; thence they pass into a condition known
as scurvy; the body emaciates, the blood becomes
thinned and is defibrinated; and the bones them-
selves become tender and brittle.

Brain and Spinal Cordf.— Pulsating headache in
the vertex every morning; stupefying headache,
with nausea; the headache recurs every day at a
certain hour; the hair falls out, and the scalp
becomes sensitive ; there is pain in the small of the
back, as if broken; the limbs are weak, trembling,
and paral3rtic.

Mtncf.— Sadness and depression of spirits, aggra-
vated by sympathy; aversion to men (a very ab-
normal feminine symptom); profuse weeping fol-
lowed by loss of memory ; difficulty in grasping and
retaining one's thoughts.

Sleep, — Falls asleep late at night, and awakens
early in the morning ; uneasy, anxious sleep ; the pa-
tient sobs and cries even while sleeping.

Accompaniments. — Blisters on the lips; violent,

AND THEIR TREATMENT, 317

unquenchable thirst ; emaciation, even with an enor-
mous appetite ; copious discharges of light urine.

Special Sphere of Action. — Melancholia following
intermittent fevers, especially those cases which have
been overdosed with quinine ; mental impairment in
young persons who have suffered with imperfect de-
velopment and from scorbutic affections; mental
depression in girls affected with chlorosis, or profiise
leucorrhea ; mental diseases of an intermittent type.

NITRIC ACID

General Action. — Nitric Acid, whether applied
locally or administered internally, is destructive in its
action. Its effects are seen in the blood, glands,
bones, skin, mucous membranes, and most charac-
teristically at the various muco-cutaneous junctions,
as the mouth or anus.

Brain and Spinal Cord, — Rush of blood to the
head ; pulsating headache as if the head were tightly
bound up as in a vise (compare Antimonium Tar-
taricum, Gelsemium, and Mercurius).

Mind. — Discontented, and inclined to weep vio-
lently ; despondent moods ; easily discouraged or ir-
ritated, and vexed by Uttle things unworthy of
notice ; anxious about himself; mental work is diffi-
cult and distastefal.

Sleep, — Wakens too early in the morning; dis-
turbed by dreams of crimes, dangers, or death.

Accompaniments. — Ragged, unhealthy ulcers, with
thin, excoriating, ichorous discharge ; thin, irritating
nasal catarrh; pains in all parts of the body, as
though a splinter or piece of glass were sticking in
the flesh ; offensive green, undigested diarrhea passed
with much straining.

318 MENIAL DISEASES

Special Sphere of Action. — This is a deep acting
constitutional remedy best indicated in scrawny,
thin, dark-skinned persons debilitated by the action
of some violent dyscrasia, usually of protracted du-
ration. It is useful in the secondary stage of syphilis,
especially if an excessive amount of Mercury has
been previously given. It is a leading remedy for the
despondency, mental weakness, and irritability
which attend profound physical disease.

NUX VOMICA

General Action. — It acts especially upon the spinal
cord, causing an excitability of both motor and
sensory centers ; it produces tetanic convulsions and
rigid flexions of the body, such as opisthotonos ; it
also produces spasmodic contractions of the muscles
of the throat, of the face, and of the intestinal and
urinary tracts.

Brain and Spinal Cord. — It produces congestion
of the brain, and stupefaction. This drug produces a
feeling as if the victim had indulged for a long time
in a heavy debauch; there is a dull, heavy pain
throughout the head, and especially over the left eye
or in the occiput ; there are spasms of the muscles on
the neck, back and limbs, sometimes so severe that
the patient stands upon his head and heels with
body curved upward.

Mind. — Intense irritability; disposition to find
fault with everything; quarrelsome; vindictive, ill-
humored (also Bryonia); oversensitive to external
impressions; cannot tolerate light or noise (also
Belladonna), music or strong odor; inclination to
kill beloved friends; inclined to commit suicide, but
too cowardly to consummate his desires; extreme
sensitiveness to the words and attention of others.

AND THEIR TREATMENT, 319

Sleep. — After long continued mental exertion, the
Nux Vomica patient is sleepless from an inability to
compose the mind and disengage himself from atten-
tion to the business he has had in hand ; falls asleep
late at night; wakens at three a. m., lies awake tos-
sing and fretting for two or three hours, falls asleep
when he should get up, and after a short morn-
ing nap awakens unrefreshed and ill tempered, his
anger rising against himself and those around him.

Aecompaniments. — Photophobia, aggravated in
the morning ; nose plugged with mucus on awaken-
ing, followed by profuse watery discharges after the
nostrils are relieved of the plug ; besotted expression
of the face ; bitter eructations, with nausea in the
morning; pressure and pain in the stomach after
eating ; constipation with ineffectual urging.

Special Sphere of Action. — This remedy is espe-
cially indicated in behalf of nervous people of seden-
tary habits ; also so-called bilious people, and those
who suffer from chronic dyspepsia, from chronic con-
stipation, and from chronic hypochondriacal melan-
cholia; mental depression from overstudy, from
overanxiety , and from overdrinking ; loss of mental
power from masturbation, and from excessive in-
dulgence with those of the opposite sex. It produces
favorable results in the cases of many people who
suffer from hard work, personal neglect, unnaturally
irascible tempers, drinking and debauchery, mental
depression, and from pessimistic views of life. Its ad-
ministration is efficacious in the relief of sleepless-
ness in such patients as we have just described, if
they will simply reverse their methods of living, and
correct their daily habits, and make them conform,
to a reasonable extent, with the simple but positive
requirements of nature.

320 MENTAL DISEASES

oproM

General Action. — It produces a general depres-
sion, torpor and paralysis of functional activity ; it
befogs the mental faculties, impedes the action of the
heart, and diminishes the secretions of the mucous
membranes.

Brain and Spinal Cord. — Congestion of the brain ;
vertigo, as if intoxicated ; pressive pains in the. head
and cold sweat upon the forehead ; cold extremities,
numbness and trembling of the limbs ; spasms in the
muscles of the back, causing the spine to curve like
an arch.

Mind. — Dulness, stupidity, loss of consciousness;
the patient acts as if in a drunken stupor ; again, the
patient becomes delirious, and has hallucinations of
sight, and sees frightfiil visions ; vivid imaginations ;
exaltations of mind; thinks herself away from
home; apprehensive and frightened at seeing small
animals ; marked inability to tell the truth ; Opium
eaters are cunning and inveterate Uars.

Sleep. — Deep, heavy sleep that is unrefreshing ;
sleeplessness from extreme sensitiveness of the special
senses; sleepless but stupid (also Gelsemium).

Accompaniments. — Chronic constipation from
paral3rtic inactivity of the bowels ; apoplectic condi-
tions; spasmodic griping, pressive pains in abdo-
men ; slow respiration ; slow pulse with sharp pains
through the chest.

Special Sphere of Action.— This drug is homeo-
pathically applicable in the treatment of those who
have long been dissipated; old people who are in-
clined to apoplexy or paralysis ; melancholia, when
the patients are at one time stupid and depressed.

AND THEIR TREATMENT. 321

and again restless, anxious and troubled with vivid
hallucinations of sight.

PHOSPHORIC ACID

General Action, — Acts upon the vegetative sys-
tem, producing waste of tissue, and marked disturb-
ance of the kidneys and male sexual organs. Under
Phosphoric Acid the male sexual organs become re-
laxed, and unable to perform their natural ftinctions.

Brain and Spinal Cord, — Sense of depression, with
confusion and dulness of the brain ; weakness in the
back and limbs.

Mind. — Absolutely indifferent to surroundings ;
unable to think ; disinclined to talk ; loss of memory ;
questions are answered very slowly.

Sleep. — Drowsy and apathetic night and day, but
sleepless after midnight.

Accompaniments. — Profuse urination ; loss of ap-
petite; weakness of sexual organs; debilitating emis-
sions ; exhaustion after coition or masturbation.

Special Sphere of Action. — Dementia from mastur-
bation, or from sexual excesses; palpitation of the
heart in young people ; melancholia from disappoint-
ment in love, from excessive menstruation, and from
physical exhaustion due tooveraction of the kidneys.

PHOSPHORUS

General Action. — It inflames and degenerates the
mucous membranes of the entire alimentary tract; it
produces an active parenchymatous degeneration of
the liver; it destroys bone, expecially the inferior
maxilla and tibia ; it causes fatty degeneration of all
tissues of the body, leads to purpuric extravasations
through disorganization of the blood ; produces san-

322 MENTAL DISEASES

guineous infiltrations of lung tissue, and inflames the
kidneys.

Brain and Spinal Cord, — Softening of the brain
and spinal cord, with persistent headache; acute
atrophy of the brain and the medulla oblongata;
congestion of the brain, with throbbing of the tem-
ples ; heat and burning in the brain and spine ; weak-
ness and heaviness in the limbs.

Mind, — Apathy, stupidity, indiflference to every-
thing; indisposition to mental or physical exertion
(also Nux Vomica and Sulphur) ; ideas slow in evo-
lution ; inability to think ; occasionally nervous, fear-
ful and hysterical.

Sleep, — Sleepless before midnight ; falls asleep, but
awakens easily many times during the night.

Accompaniments. — Hoarseness; hollow, spas-
modic cough ; expectorations streaked with blood ;
short, labored respiration ; great weakness, prostra-
tion and emaciation.

General Sphere of Action, — Insanity from mastur-
bation or excessive sexual indulgence; insanity re-
sulting from phthisis; cerebral softening; spinal
softening; locomotor ataxia; paralysis following
wasting diseases. It tends to delay the processes of
cerebral degeneration, and hence it is of great value
not only in relieving the sleeplessness of those suffer-
ing with organic brain disease, but it tends to ward
off" and hold in check approaching apoplexy and pa-
ralysis. It is sometimes combined with other drugs ;
and a useful constitutional remedy, and a nutrition-
improving remedy is found in Calcarea Phosphorica.
Also the brain fag of strong but overtaxed mental
workers is relieved by the use of Phosphide of Zinc.
But Phosphorus itself is a wonder-working brain
remedy if judiciously applied. The sleeplessness of

AND THEIR TREATMENT. 323

Phosphorus is characterized by short naps, and fre-
quent wakings during the night.

PLATINA

General Action. — Acts upon the nerve centers, pro-
ducing depression of the sensorium and derangement
of the entire nervous system.

Brain and Spinal Cord, — Sensation of numbness
or coldness in the head ; sensation in the temples as
if the head was tightly bound, or as if the various
parts were closely screwed together; sensation of
cold spots on the temples.

Mind. — Full of unnecessary pride ; looks with con-
tempt upon those around her ; fancies herself great,
and that her neighbors are small, insignificant and
weaker than herself in both mind and body ; at times
depressed, inclined to weep, feels lonesome, but too
proud to associate with her friends.

Sleep. — Indulges much in spasmodic yawnings ; is
very sleepy, but sleep is light and often broken.

Accompaniments. — Inflammation of the ovaries,
with paroxysms of burning pain; sensitiveness of
the female genital organs; voluptuous inclinations^
with anxiety and palpitation of the heart.

Special Sphere of Action. — Mania with pride ; mel-
ancholia complicated with hysteria; nymphomania
due to inflammation of the ovaries. This drug is
especially adapted to the treatment of hysterical
females. It is often given for monomanias of pride
and grandeur. These patients are haughty and dic-
tatorial, overbearing and faultfinding; look down
disdainfiiUy on others.

324 MENTAL DISEASES

PODOPHYLLUM

General Action. — Its chief action is upon the ab-
dominal viscera, resulting in a profuse, forcibly ejected
diarrhea, and a secondary torpor, and congestion of
the liver. Reflexly, symptoms of cerebral irritation
follow.

Brain and Spinal Cord, — Vertigo, with sensation
of falling forward; headache; rolls the head and
moans; pain between the shoulders, and along the
spine in the morning.

Mind. — ^Depression of spirits ; imagines that he is
going to die ; has a disgust for life on account of tor-
menting gastric difficulties.

Sleep. — Heavy sleep; vertigo on awakening;
moaning in sleep (also Belladonna).

Accompaniments. — Diarrhea, with frequent, yel-
low, painless stools; stools with a meal-like sedi-
ment; sour smelling stools, with flatulence; bloody
stools, with prolapsus ani; diarrhea worse in the
morning. On the other hand, there may be constipa-
tion, with clay-colored or chalky stools (Mercury);
general appearance of jaundice; dyspepsia; yellow
coated tongue; alternation of diarrhea and consti-
pation (also Nux Vomica).

Special Sphere of Action. — Hypochondriacal mel-
ancholia following abdominal disorders, or accom-
panied by diseases of the digestive organs.

PULSATILLA

General Action. — Pulsatilla, through the cerebro-
spinal system, works its effects upon the mucous and
serous membranes, upon the veins, upon the gener-
ative organs of both sexes, upon the ears and eyes.

AND THEIR TREATMENT. 325

Among its general effects are increased catarrhal dis-
charges from all mucous surfaces.

Brain and Spinal Cord, — The brain symptoms
seem to rise by reflex action from diseased conditions
of other organs of the body ; there is headache, with
suppression of the menses; headache from over-
loaded stomach, especially after eating fat food;
headache after catarrh of the nasal and bronchial air
passages ; stiffness and rheumatic pains in the nape
of the neck ; pain in the small of the back as from a
sprain; hip joint painful as if dislocated; drawing,
tensive pain in the thighs and legs.

Mind. — Constant inclination to weep; gentle,
timid and yielding disposition ; at the same time fret-
ful, morose, and easily put out of sorts. Fretfulness
and fearfulness are the chief characteristics of the
Pulsatilla patient.

Sleep. — Sleeplessness from effects of late suppers, or
from eating too much ; sleepless the first half of the
night ; sleeps freely toward morning ; screaming and
whining in sleep on account of vivid or frightful
dreams.

Special Sphere of Action. — Pulsatilla is a remedy
of frequent service among insane women who suffer
with disordered menstruation. Pulsatilla patients
are of a mild, gentle, yielding disposition, disposed to
cheerfulness, and yet manifesting a changeable and
fickle disposition, often smiling in the midst of tears.
When the menses are delayed or absent, Pulsatilla is
of great service in establishing the flow, and among
insane women this is frequently followed by improve-
ment in the mental symptoms. Religious melan-
cholia, especially in women who are weak in body,
and anxious and apprehensive in mind. It is espe-
cially applicable to those states of hypochondriacal
depression preceded or accompanied by profiise ca-

326 MENTAL DISEASES

tarrhal discharges, and by inflammatory conditions
of the genital organs in both sexes ; acute glandular
affections, particularly in the breasts and testicles;
recent gastric disorders ; inflammatory states of the
eye and ear.

RHUS TOXICODENDRON

General Action, — Acts upon the cerebrospinal
system; upon the skin, the lymphatic glands, and
the muscular tissues ; it produces conditions simulat-
ing rheumatism, erysipelas, and typhus fever.

Brain and Spinal Cord. — Congestive headache^
with burning in the ears and vertex ; vesicular erup-
tions upon the scalp; fulness and heaviness, and
sensation of weight in the forehead ; rheumatic pains
in the back and joints of the shoulder, arm and
wrist ; fulness and pain in the limbs on first moving
in the morning; relieved by constant motion.

Mind. — Absence of mind; forgetful, difliculty in
remembering the most recent events; apprehensive-
ness ; anxiety, with restlessness ; cannot stay in bed ;
delirium ; thinks he is walking over large fields ; sui-
cidal and wants to drown herself; fears she is being
poisoned.

Sleep. — Repeated yawning, without being sleepy ;
dreams of taking severe exercise, and awakens very
much exhausted as a result of these dreams.

Accompaniments. — Diseases of a rheumatic na-
ture ; erysipelas, with mild delirium ; eruptions upon
the skin of a vesicular type ; great debility, with
restlessness ; fever of a rheumatic type, with marked
cerebral disturbance.

Special Sphere of Action.— Mental depression in
rheumatic patients, with great physical restlessness ;

AND THEIR TREATMENT, 327

delirium accompanying diseases which result from
exposure to storms.

SECALE CORNUTUM

General Action. — Acts upon the cerebrospinal sys-
tem, and upon the great sympathetic system; it
afiFects the vasomotor nerves and causes contrac-
tion of the coats of the blood vessels. The contrac-
tions are followed by relaxations and by irregular
dilations of the blood vessels. Secale also produces
blood disorganization, and gangrene of the extremi-
ties.

Brain and Spinal Cord. — Congestion of the brain,
and vertigo ; subsequently, it causes cerebral and
spinal anemia ; pain and confasion in the head ; sen-
sation as if the contents of the skull w^ere being
washed about; spinal paralysis with rapid emaci-
ation ; spasmodic jerkings of paralyzed limbs ; pain-
ful contractions of flexor muscles ; tingling in limbs ;
sensation as if ants were crawling over the skin.

Mind. — Apathetic, stupid, unable to think quick-
ly ; from a dull mental state the patient sometimes
rises to a condition of mania with inclination to
bite. Again, there is great depression of mind, with
sadness and fear of death; yet with this fear of
death there are, oftentimes, suicidal tendencies (also
Arsenicum), especially by drowning.

Sleep. — Drowsiness; stupor, with frequent yawn-
ing ; great inclination to sleep, but sleep is disturbed
by frightful dreams.

Accompaniments. — ^Uterine hemorrhage; prostra-
tion of strength; tendency to emaciation; small,
rapid, and sometimes fluttering pulse; anxious,
labored inspiration, with constant tendency to sigh ;

328 MENTAL DISEASES

cold extremities; cramps in limbs, and sometimes
convulsions.

Special Sphere of Action, — This drug is particu-
larly adapted to the relief of mental diseases occur-
ring in weak and scrawny women, in feeble and aged
persons, or in those who have become, by effects of
disease, prematurely old. It is useful in mental de-
pressions after hemorrhages and other exhausting
bodily disorders.

SEPIA

General Action. — It acts apparently upon the great
sympathetic system; it produces congestive effects
upon the female sexual organs, and upon the liver.
It also induces cerebral anemia.

Brain and Spinal Cord. — Boring headache accom-
panied by vertigo ; shooting pains in the head ; hemi-
crania; sensation as if the head would burst; ag-
gravated by stooping, coughing, or motion ; pain in
small of the back, with much stiffness ; pain relieved
by walking (also Rhus Toxicodendron); heaviness
and weakness of the limbs.

Mind. — Sensitive and sad ; much inclined to weep
(also Natrum Muriaticum and Pulsatilla) ; at times
apathetic and indifferent; again fretfal and easily
offended ; dread of being alone ; apprehensive of the
fiiture, and has great fears concerning her health.

Sleep. — Sleepy during the da3rtime and early in
the evening; awakens at three a. m., and cannot
sleep again; (Nux Vomica patient wakens at three
A. M., but after a time falls asleep, and sleeps till late
in the morning) ; talks loudly in sleep ; sleepless from
rush of thoughts ; awakens at night, with palpita-
tion and anxiety about things that happened years
ago.

AND THEIR TREATMENT, 329

Accompaniments. — Yellow^, waxy complexion,
with general puflFed appearance of the face; yellow
spots on the skin ; pains in the uterus, with a sensa-
tion as if the contents of the pelvis would protrude
through the vulva. Dyspepsia, with an all-gone sen-
sation in the pit of the stomach ; excessive prostra-
tion after uterine disease.

Special Sphere of Action. — Sepia is a valuable
remedy for mild cases of melancholia in chlorotic,
puffy, and pot-bellied women, and for those who
have suffered from miscarriages, from difficult labors,
from profuse menses, and from chronic leucorrhea.
It is valuable for mental depression following the
condition known as subinvolution of the uterus.

SILICEA

General Action.— It acts upon the sympathetic
system, and produces marked eflfects upon the glan-
dular structures, the bones, and the mucous sur-
faces. Silicea has a marked control over the sup-
purative process.

Brain and Spinal Cord. — Headache from conges-
tion of the brain, with excessive sensitiveness of the
nervous system; headache aggravated by noise,
motion and stooping ; headache produced by the ex-
citement of the passions; the headache is severe,
throbbing, shooting and burning in character; the
Silicea headache is usually circumscribed, and may
effect the occiput, the vertex, or the forehead ; the
Silicea headache is relieved by warmth, and by care-
fiiUy binding up the head with a cloth (also Ar-
gentum Nitricum) ; the spine is sensitive to touch ;
there is formication of the limbs, and a feeling of
weakness in walking, produced by spinal debility.

. Afinc?.— Weak-minded ; desponding; low-spirited;
22

330 MENTAL DISEASES

wishes to drown herself; compunctions of conscience
about trifles ; yielding disposition ; faint-hearted ; has
no "sand.**

Sleep, — Somnambulism; has anxious dreams of
murder; has lascivious dreams; jerkings of the limbs
during sleep.

Accompaniments. — Abdomen hard and tense ; con-
stipation; attempts at stool are but partially suc-
cessful ; swollen and hardened glands ; great debility ;
ulcers, with stinging burning, pains; small wounds
heal with great difficulty.

Special Sphere of Action. — It is indicated in pro-
found melancholia with symptoms like the forego-
ing; in melancholia accompanied by boils, carbun-
cles, abscesses, ulcers, or swollen glands. When we
wish to remove or relieve deep-seated and long-last-
ing effects of defective assimilation, we think of
Silicea. It corresponds well with what the older
writers called the "scrofulous diathesis," attended
by suppurative processes affecting either the glands
or the osseous system. It is also a safe and useful
remedy in epilepsy, where the causes arise from mal-
development, and where aggravations occur either
weekly or monthly.

SPONGIA

General Action. — It produces enlargements and
indurations of the ductless glands, especially the
thyroid, with irritation of the trachea and larynx.

Brain and Spinal Cord. — Congestion of the brain ;
dull headache on the right side ; sharp stitches in the
temples ; painfiil stiffness in the muscles of the neck
and back ; twitchings in the muscles of the limbs ; ex-
haustion and heaviness of the body after the slight-
est exertion.

AND THEIR TREATMENT. 331

Mind, — Irresistible desire to sing; the Spongia
patient is jolly like Hyoscyamus, but the gaiety of
spirits is longer continued and less variable than in
Hyoscyamus.

Sleep, — Sleepy during the day; sleep interrupted
by dreams at night.

Accompaniments, — Great difficulty in breathing;
hoarse, hollow cough; the patient is wheezing and
asthmatic, and yet constantly inclined to sing.

Special Sphere of Action, — Mania, with gaiety of
spirits; women and children who are lighthearted
^nd hopeful, but who have strong tendencies to
phthisis.

STRAMONIUM

General Action, — Acts upon the sensorium, stimu-
lating it to undue activity, and inducing hallucina-
tions of sight and hearing of the most vivid char-
acter; it also produces suppression of urine; great
«exual excitement; tendency to convulsions; fiery
eruptions of the skin, and dryness of the throat, with
fear of water.

Brain and Spinal Cord, — ^Violent congestion of
the brain ; excessive heat in the head ; pulsations in
the forehead, but less violent than those Induced by
Belladonna; twitchings of the hands and feet, and
trembling of the limbs; cataleptic states.

Mind. — Extraordinary mental excitement ; sudden
^nd kaleidoscopic changes in the mental state; at
times fuU of horrible fears ; at times merry, and en-
jojring himself by singing and dancing; at times
proud, haughty, and intolerant of those around
him; at times fall of rage, trying to strike with
^eat vigor those within his reach ; and again, dul-
ness of the senses, with stupid indifference to every-

332 MENTAL DISEASES

thing about him. Fear and hope, jollity and rage^
frenzy and apathy follow each other in rapid succes-
sion under Stramonium; the passions and the
mental manifestations become strangely jumbled
in their exhibition under the influence of this stimu^
lating drug. The Stramonium patient desires light
and company, and at the same time is often terrified
by bright objects, and seeks to fight those whom
he constantly wishes to have in his presence. He
has hallucinations of sight during which horrible
images are conjured up, and horrible animals are
seen jumping out of the ground and running at their
affrighted victim.

Sleep, — Deep, heavy sleep, with snoring or stertor-
ous breathing; the heavy sleep is short, and the
patient is often roused, apparently by seeing horrible
objects in his dreams ; twitching and cramping dur-
ing sleep.

Accompaniments. — Suppression of urine ; convul-
sions from the sight of bright objects ; trembling of
the whole body as if from fright ; difficulty of deglu-
tition; spasms are often excited when water is
placed at the lips of the Stramonium patient ; under
Stramonium, the sexual desires of both sexes are
greatly increased.

Special Sphere of Action. — Chorea, epilepsy, hy-
drophobia, hysteria, delirium tremens, and, most of
all, acute mania when the patient rises to a condi-
tion of mental frenzy, far surpassing the exaltation
of the Hyoscyamus case, but when the actual in-
flammatory condition of the cerebrum is of a milder
degree than that found under Belladonna. This
remedy will be found of service when the patient is
greatly agitated and extremely fearful of everjrthing
that he hears or sees. He has the horrors, so to

AND THEIR TREATMENT. 333

Speak, and is in constant dread of being attacked by
all kinds of terrible animals. One patient who at
times imagines that snakes are pursuing her, has
frequently been quieted, and this symptom dispelled
by a few doses of Stramonium. The nurse in charge
has noticed this eflfect, and when the vision of snakes
appears to this patient, she sends to the attending
physician, and asks for some of the ** snake medi-
cine *' for the patient. Stramonium is a remedy
adapted to the relief of maniacal attacks which
sometimes appear in paretics before or after epilepti-
form seizures.

STAPHISAGRIA

General Action, — It produces a chronic irritation
and hyper-excitability of the male genital organs,
particularly of the prostatic urethra and the adja-
cent seminal ducts ; and secondarily develops all the
physical and mental symptoms of spermatorrhea.

Brain and Spinal Cord, — Stupefying headache, or
as if a round ball were in the forehead, which per-
sists even when shaking the head.

Mind, — Very peevish ; easily offended ; becomes in.
•dignant; thinks the least thing done is a premedi-
tated insult; hypochondriacal or apathetic mood;
prefers solitude, and is shy of the opposite sex ; ob-
tuseness of mind ; thoughts vanish while speaking or
thinking.

Sleep. — ^Uneasy sleep, with anxious dreams, or
dreams of the previous day's work. Amorous
dreams, with seminal emissions.

Accompaniments, — Weak, pale and sallow, with
dark rings beneath the eyes, from masturbation or
excessive sexual intercourse. Great lassitude and
indolence; eczematous eruptions; pains in the long

334 MENTAL DISEASES

bones ; excoriating coryza, and relaxation of the ali-
mentary canal, with desire for spices, wine or other
stimulants.

Special Sphere ot Action. — It finds its principal
employment in removing the results of excessive
masturbation in either sex. These cases are weak,
firetfiil, lacking in self-control, unable to concentrate
the mind ; their nervous systems are exhausted, and
their own ailments are the constant subject of their
contemplation, and should, in their opinion, be a.
topic of unfailing interest to every one else.

SULPHUR

General Action. — It acts upon the ganglionic ner-
vous system, and it works its eflfects most pro-
foundly throughout the entire vegetative sphere
Every organ in the body is affected by the adminis-
tration of Sulphur ; but we look for its most promi-^
nent results in the skin, the mucous membranes, the
lymphatic glands, and the venous circulation.

Brain and Spinal Cord. — Sulphur produces a rush,
of blood to the head; a pressive frontal headache^
w^orse in the morning; headache in the vertex as
from a weight ; a headache with vertigo while walk-
ing or stooping; a headache, with great confusion
in the head, and a sensation as if a band was bound-
around the forehead (also Cocculus and Mercurius);
there is stiffness in the neck and back ; bruised pain
in the small of the back and the coccyx; tearing,
drawing, rheumatic pains in the shoulders, arms and
legs ; burning in the soles of the feet.

Mind. — Intense anxiety and apprehension, espe-
cially in the evening (also Calcarea Carbonica) ; in-
dulgences in philosophical speculations are followed
by abnormal mental exhaustion, and an inability ta

AND THEIR TREATMENT, 336

hold his mind to work upon any subject; at times
fretful and ill-humored ; at times indolent and indis-
posed to exercise ; at times sad, melancholy, inclined
to weep, and despair of salvation.

Sleep, — Often wakeful during the entire night;
when the patient does sleep he awakens frequently
(also Phosphorus); anxious and vivid dreams accom-
panied by startings during sleep, especially soon
after falling asleep ; insufficient sleep at night, and ir-
resistible drowsiness during the day.

Accompaniments, — Great sensitivess of the scalp
and skin generally ; sensitiveness of the eyes to light ;
sensitiveness of the ears to loud noises ; toothache,
with great sensitiveness to cold water and cold air ;
distention of the abdomen from incarcerated flatu-
lence, and great sensitiveness of the abdomen to
touch ; hoarseness ; dry cough in the evening or on
waking ; pains and sensitiveness in the joints. The
Sulphur patient is sensitive in all his organs, and is
opposed to all external impressions. He dreads ex-
ercise or contact with others; he dreads fresh air;
he dreads to take a bath, on account of being so in-
tensely sensitive.

Special Sphere of Action. — Sulphur is particularly
adapted to lean, sensitive and phthisical persons
who are inclined to religious melancholy; such pa-
tients become depressed and discouraged because
their minds are constantly disturbed by every im-
pression or experience in life. We are obliged to pre-
scribe Sulphur for the insane more on account of
the external symptoms than because of any special
mental characteristics. As a characteristic of the
Sulphur patient, it has been said that he uses his
sleeves both for ** handkerchief and looking-glass.*'
He is dirty, and looks dirty; has an aversion to

336 MENTAL DISEASES

water, and to washing; the skin is harsh and un-
clean; the habits are untidy. Mentally, he is irri-
table and a chronic grumbler. Sulphur is frequently
useful in the treatment of patients with chronic
mania who attach great value to trifling objects,
who dress themselves up in rags, wear paper crowns,
and imagine that they are kings and queens. The
Sulphur patient is selfish, and is anxious about his
own salvation, but indifferent to that of others. In
cases of this sort. Sulphur is usefiil as a constitu-
tional remedy, and it prepares the system for the
beneficial effects of other remedies. When mental
symptoms are not well pronounced in a case of in-
sanity, a few doses of Sulphur will often lead the pa-
tient to disclose characteristic conditions of the
mind, and insane delusions which have heretofore
been concealed.

THUJA

General Action, — It produces a tendency to acrid
secretions, especially about the anus and genital or-
gans ; constitutionally, it produces partial disorgani-
zation of the blood, and a tendency to wasting of
tissue.

Brain and Spinal Cord. — Dull confusion in the
head ; vertigo as soon as the eyes are closed, or upon
suddenly turning the head. (Lachesis has vertigo
from looking steadily at one object). Headache as if
a nail were driven into the head (also Ignatia).

Mind, — Disinclined to be touched or even ap-
proached ; thinks he is made of brittle material and
may break; thinks his limbs are separated (also
Baptisia) ; or that a living animal inhabits his abdo-
men, which he feels moving there. Either hurried in

AND THEIR TREATMENT, 337

manner and ill-humored, or is unable to recall needed
words, and is slow in speech and thought.

Sleep. — Falls asleep late owing to persistent rest-
lessness; lascivious dreams without emission of
semen, wakes. unrefreshed.

Accompaniments. — Warty growths upon the skin
or mucous membranes, seedy or cauliflower-like in
structure. Sight blurred ; sees apparitions upon clos-
ing the eyes; greenish yellow gonorrhea; neuralgia,
beginning over the eye, and seeming to extend back-
ward over the head. (Gelsemium and Spigelia extend
forward).

Special Sphere of Action.. — It is called for in states
of mental depression and apathy, with desire to be
left alone, when this frame of mind follows direct and
personal knowledge that the way of the transgressor
is hard. Thuja corrects the physical susceptibility
which adds to the severity of non-syphilitic venereal
disease, and removes the lowness of spirits, self-de-
preciation and loathing of life which is often found
with severe disease of the sexual organs. In ordi-
nary hypochondriacal melancholia thje delusion that
a living creature is in the abdomen, or that his mem-
bers are changed in structure, will not infrequently
guide to its successftil application.

VERATRUM ALBUM

General Action. — This drug acts upon the cerebro-
spinal system, at times to the extent of producing
convulsions; it disorganizes the blood, and impairs
the circulation ; it produces collapse, vomiting, purg-
ing, spasmodic colic, and clammy perspiration.

Brain and Spinal Cord. — Congestion of the brain
when stooping ; headache as if the head would burst ;
dull pressure in the vertex ; coldness as if ice were on

338 MENTAL DISEASES

the vertex; paralytic weakness of the limbs; limbs
feel as if asleep ; hands and feet feel bruised and icy
cold ; cramps in the calves of the legs.

Mind. — ^Anxiety and apprehension ; a tendency to
weep, and howl, and scream over some dreaded mis-
fortmie; tendency to tear and cut clothing; when
the rage of mania subsides, there is a tendency to
converse about religious matters; the religious na-
tures of the Veratrum patients become chameleon-
hued in their manifestations ; they pray and curse in
alternation for many hours in succession; finally
these patients despair of salvation, and of their po-
sition in society. When disengaged from religious,
contemplation, the Veratrum patients are inclined to
gossip, to find fault with others, to scold their
friends, and to call their neighbors hard names. The
Veratrum patient sometimes fancies herself preg-
nant, even w^hen eighty or ninety years of age.

Sleep. — At times very sleepy and drowsy ; at times
exalted and sleepless for days and nights in succes-
sion, sleeplessness from undue mental activity, pre-
ceding a state of physical collapse.

Accompaniments. — Pale, sunken face, with blue
nose, and cold perspiration on the forehead ; violent
vomiting, first of food, and then of green, slimy^
viscid liquid ; profiise, painful and violent diarrhea ;
discharges sudden and involuntary, with cramping
pains in the bowels, and in the calves of the legs;
great difficulty in respiration; palpitation of the
heart, with anxiety ; sudden failure of the strength •
extreme prostration, with coldness and a tendency
to cramps.

Special Sphere of Action.— Acute mania with rapid
exhaustion; acute dementia with prostration and
coldness of the extremities ; acute melancholia with

AND THEIR TREATMENT, 339

intense anxiety and despair of salvation, particu-
larly in \7omen whose menses have been suppressed,
or in women who fancy themselves pregnant.

VERATRUM VIRIDE

General Action. — Acts upon the cerebrospinal
system, and especially upon the pneumogastric
nerve, disturbing the circulatory apparatus, and
causing congestion and inflammation of the brain
and other organs; it produces intense prostration
and tendency to spasms ; it causes a strong beating
of the heart, and a quick pulse, but a slow respi-
ration.

Brain and Spinal Cord, — Headache proceeding
from the nape of the neck ; active congestion of the
brain, followed by vomiting; cutting pains in the
neck and shoulders; cramps in the legs and hands;
shocks like electricity pass rapidly through the limbs ;
convulsive twitchings of all the muscles of the ex-
tremities.

Mind. — Intensely quarrelsome and delirious ; from
a condition of excitability and quarrelsomeness the
patient passes into a state in which she is sullen,
suspicious, and distrustful of those around her ; the
Yeratrum Viride patient has in mind a constant fear
that she will be insane (also Sepia, Calcarea Car-
bonica and Lilium Tigrinum) ; also thinks she will be
poisoned.

Sleep. — ^Restless each night, but generally secures
some sleep ; is disturbed by frightfial dreams of being
on the water, and of being drowned.

Accompaniments. — Convulsions before, during
and after labor; intense nausea and vomiting; cut-
ting neuralgic pains in the abdomen ; profuse urine,
which is pale ; active congestion of the chief organs

340 MENTAL DISEASES

of the body ; slow, weak pulse, or palpitation, with
fluttering sensation in region of the heart, with quick
pulse.

Special Sphere of Action. — Puerperal mania ; gen-
eral paresis ; particularly after convulsions ; epileptic
mania, with frequent convulsive attacks ; hysterical
mania ; melancholia, with a tendency to chorea ; mel-
ancholia or mania following cerebrospinal fever.

ZINCUM METALLICUM

General Action. — Its general action resembles that
of lead in the physical weakness produced through
nerve exhaustion and anemia. The cerebrospinal
system is most affected.

Brain and Spinal Cord. — Sharp, lancinating head-
aches low in the occiput, or in the root of the nose.
Burning pain along the whole course of the spinal
cord; a sense of formication in the limbs; cannot
hold the feet still ; the muscles jerk voluntarily ; the
hands tremble; sharp pains are experienced along
the course of the peripheral nerves-
Mind. — Sad, morose and dejected, with thoughts
of death, which he considers indifferently and with-
out fear ; or, fretful and irritable, with great aversion
to noise ; starts at every unexpected sound. Again,
there may be difficulty in comprehending, which
leads the patient to repeat all questions before en-
deavoring to answer.

Sleep. — Sleeps poorly; dreams of filth, of being
pursued, or of terrifying experiences ; wakens in a
fright.

Accompaniments. — Nausea and vomiting as soon
as food touches the stomach ; hydraemia, venous con-
gestions, and a tendency to varicose veins m the ex-
tremities ; dryness and thickening of the skin.

AND THEIR TREATMENT. 341

Special Sphere of Action, — When prolonged men-
tal overwork and close confinement have produced a
state of forgetfnlness, mental weakness, inability
to apply the mind, broken and tinrefreshing sleep,
Zincum becomes a most valuable remedy, aided by
rest, and change of scene. Many cases of melancholia
present mental exhaustion as their immediate cause,
and are helped by its administration ; and it is used
when defective reaction and lack of trophic power
retard recovery.

INDEX

Page.

Aconite 264-266

mania 237, 241

melancholia 265

Acute delirious mania . , , 143

diagnosis 143-144

prognosis 144

symptoms 144

Acute mania 132

bed treatment for . . .215

causes 128

illustrative cases . . 136-137

prognosis 136

remedies 237

Acute delirious melancholia. 116
illustrative case . . . .119

symptoms .116

treatment 117

Acute melancholia 100

bed treatment for . . .215

delusions 95

illustrative case .... 102

remedies 233

suicide 102

symptoms loo-ioi

terminations 102

Acute dementia 162

causeis 163-166

differential diagnosis

160, 170
hereditary predisposi-
tion 164

pathology 180

prognosis 169

symptoms 168

treatment 243

Page.

Agaricus muscarius 266

Age of brain maturity ... 17

Agnus castus 243

Alcoholic dementia .... 176

pathology jgo

Allen J4Q

Alumina 267

Anacardium 268

dementia 243

mental weakness . . . 235
Antimonium crudum .... 269
Antimonium tartaricum . . 270

Appetites, the 25

Apis mellifica 271

dementia 243

Arachnoid, the ..... n
Argentum nitricum .... 272

Arnica 273

Arsenicum 274

mania 276

melancholia . . . 233, 276

neuralgia 276

sleeplessness 276

Artificial feeding 221

Aurum metallicum . . 276-277

melancholia 233

Automatic fire extinguisher. 255
Avenasativa in sleeplessness 63

Baillarger hq

Bain 22

Bakery 260

Ball . . So

Baptisia 277

mania 242

344

INDEX,

Page.

Baths 217

Bayle 182

Bedlam 71

Bedstead 251

Bed treatment 215-217

advantages 216

Bell 182

Belladonna 278

mania 237

sleeplessness 65

Blandford 82, 146

Brain, the human 9

capabilities 26

coverings 10

development 16

functions 17

hemispheres 12

maturity 17

membranes 11-12

seat of mind 20

uses 27

ventricles 15

weight 16-17

Brigham 182

Boiler-house 261

Browne .... 146, 162, 1671 169

Bryonia 280

peevishness 241

Bucknill 157

Bucknill & Tuke iii

Buildings for care of the

insane 247

Burton 35

Cactus grandiflorus .... 281
melancholia 235

Calcarea carbonicum . . . 282
dementia 243

Calcarea phosphoricum . . 284
dementia 243

Calmeil 182

Page.

Camphor, 284

Cannabis indica 285

Cantharis 286

mania 242, 243

Capabilities of the brain . . 26

Cardan 62

Catalepsy in acute dementia 16&
cannabis indica .... 285

Causticum 288

Cerebellum, the 16

Cerebrum, the 12

Chamomilla 289

peevishness 234

sleeplessness 65

China 290

Chronic dementia 170-

pathology 180

prognosis 172

symptoms .... 170-172

Chronic mania 141

definition 142

delusions 142

prognosis 142

Chronic melancholia . . . 105
illustrative case .... 106

symptoms 105

terminations 105

Cicuta virosa 292

Cimicifiiga 292

melancholia .... 236

sleeplessness 65

Circular mania 145

Classification of mental ac-
tivities. Bain 22

Clouirton

142, 146, 155, 201, 202, 203
Coca er3rthroxylon in sleep-
lessness 63

Cocoon, the 220

Cocculus 294

Coff ea cruda 295

INDEX.

345

Page.

CojQfea hysteria 234

sleeplessness 65

Colchicum 296

Cold storage building . . .261

Colocynth 296

Combe 76

Commitment, requirements

for 85

blank forms . . . . 85
contraindications . • 92, 93

necessity 92

Compendium of materia med-

ica 264

Conditions for a good mem-
ory 22

Congregate dining-rooms . 259
Conium maculatum .... 297

Conscience, the 24

Constipation, treatment of . 135
Cotton felt mattress .... 258
Convolutions, brain .... 13
Cuprum aceticum in epilep-
tic dementia 243

Cuprum metallicum .... 298

Damiana in masturbatic de-
mentia 243

Daute 208

Decorations in hospitals . . 257

Delusions 77

causes 78

varieties 79

Dementia 159-181

differential diagnosis . . 160

forms 161

nature and definition . 159

pathology 180

remedies 243

Dementia, acute 162

causes 162-166

differential diagnosis . . 160

23

Page.
Dementia, hereditary predis-
position 163-164

180
169
166-169
170
176
180
170
180
172
171

175
177

173

243

174

174
176

176

176
161
266
268

pathology ....

prognosis ....

symptoms ....

treatment ....
Dementia, alcoholic .

pathology . . .
Dementia, chronic .

pathology ....

prognosis ....

symptoms ....
Dementia, epileptic .
Dementia, katatonic .
Dementia, masturbatic

remedies . .

symptoms .

treatment .
Dementia, organic

causes . . .

prognosis . .
Dementia, primary

Agaricus

Anacardium .

differential diagnosis

III, 160
Dementia, remedies .... 243

Anacardium 243

Apium virus 243

Calcaiea carbonicum . . 243

Calcarea phosphoricum

243, 284

Phosphoric acid . . 243, 321
Dementia, senile . . . 177-180

diagnosis ..... 180

symptoms 178-179

162

25
16

32

33

Dementia, terminal . .

Desires, the

Development of brain .

Diathesis, the insane . .

causes, acquired . .

346

INDEX.

Page.

Diathesis, causes, inherited . 52

clinical case 35

evidences 45

prevention 48

remedies 50

Dickens , . . . . 75, 127, 46

Dietetics 223-227

Digitalis 299

melancholia 235

Dining-rooms 259

Diogenes 35

Disputed forms of mania . . 155

Duncan 31

Dura mater, the 11

Durham 56, 201

Dynamo plant 261

Earle 182

Emotions, the 24-25

Enforced protection . . 218-220

protection sheet . . . .218

Epileptic dementia . . . .175

Epilepsy, nursing 244

Epilepsy, remedies .... 243

Aconite 266

Argentum nitricum . . 272
Cuprum metallicum . . 298
Oenantha crocata . . . 243

Silicea 244, 329

Esquirol 37, 94, 160

Feeding the insane . . . .221

frequency 224

Ferrier 19

Ferrum metallicum .... 300

Fire escapes . . 257

Fire extinguishers 256

Fire protection 254

Fleming 55

Fleurens 19

Food, selection of 226

Forced feeding 221

Page.

Fox 157

Furnishings 257

Galen 62

Gelsemium 301

melancholia . . . 235, 302

sleeplessness 65

General paresis .... 182-210
bed treatment .... 205-6

causes 200-2

convulsions 190

definition 183

differential diagnosis

183-184
illustrative cases . . 191-197

pathology 203

physical signs . . . 1 86-191

prevention 207

prognosis 205

stages 184

symptoms .... 1 86-1 91

treatment 205-206

General paresis, remedies . 244

Agaricus 266

Cannabis indica .... 285

Cicuta . 292

Cimicifuga 292

Hyoscyamus 305

Ignatia 307

Mercurius 314

Veratrum viride .... 339

Glonoin 302

Grauvogl • • 31

Hahnemann . . . . 64, 71, 232

Hallucinations 80

causes 81

influence on prognosis . 83

Heating 250

methods 250-254

Helleborus niger 303

Hemispheres, brain .... 12

INDEX,

347

Page.

Hepar sulphur 304

Hippocrates 70

Hitzig 19

Home treatment of insanity 212
Hospital buildings .... 248

arrangement 248

construction 248

cottages 250

decorations 257

fire protection .... 254

heating 250

lighting 250

location 247

size 247

ventilation 250

wards 249

Hospital construction . . . 245

bakery 260

boiler house 261

buildings 247

cold storage plant . . .261

dining-rooms 259

dvnamo room 261

kitchen 260

laundry 261

outbuildings 262

site 246

Hospital idea, the . . . 72, 231

Hot milk . 224

Hubbard 34

Hughlings-Jackson .... 56
Huxley, classification of . . 16

Hyoscyamus 305

mania .... 237, 238, 239

sleeplessness 66

Hypericum 306

Hysterical mania 155

Idiocy ....
Ignatia ....
melancholia

160

307
234

Page.

Illusion 83

Imbecility 160

Intellect, seat of 20

Intellectual faculties .... 21

Intelligence 23

Insane diathesis 32

causes, acquired .... 38
causes, inherited ... 34

clinical case 35

evidences 45

prevention 48

remedies 50

Insane, early care of the . . 71
Hahnemann on care of

the 71

hospital care of the . . 72
Insanity, classification ... 72
American classification 74
among ancient peoples . 70
British classification . . 73
cured by traumatism . . 151

definitions 76

earliest referenoe ... 69
from a legal sta'ndpoint 76
general treatment . . .214
medical treatment . . . 232

theories 75

Insomnia '68

causes 57

remedies 62

Iodine 309

Jeremiah 70

Johnson 132

Judgment, the 23

Kali bromidum in sleepless-
ness 63

Katatonic dementia .... 177
Kindness in care of the in-
sane . 214

348

INDEX.

Page.

Kitchen . 360

Kleptomania 156

Lachesis 310

mania 241

I^Lundry 261

Laurocerasus in epiplepsy . 243
general paralysis . . . 244

Lemnius 62

Lighting of insane hospitals 250

lyilium tigrinum 312

malancholia 236

Lobes of brain 13

Localization of brain func-
tions . 18

Longet 19

Lycopodium 313

Lypemania 94

Mania 127-158

causes 128

forms 131

pathology .... 156-157
Mania, acute delirious . . .143

diagnosis 143, 144

prognosis 144

symptoms 144

Mania, acute 132

bed treatment for . .215

causes 128

illustrative cases . 136, 137

prognosis 136

remedies 237

Mania, chronic 141

definition 142

delusions . .... 142

prognosis 142

Mania, circular 145

Mania, disputed forms . . . 155

Mania, hysterical 155

Mania, moral 156

Mania, periodic 145

Page

Mania, puerperal 153

causes 153

illustrative case .... 155

remedies 305-340

Mania, recurrent • • . . 145

Mania, remedies 237

Aconite 237,241

Agaricus 266

Arsenicum 274

Baptisia 242, 277

Belladonna . . 237, 239, 278

Cantharis 242

Glonoin 302

Hyoscyamus . 238, 239, 305

Lachesis 241

Nux vomica 241

Picric add 287

Platina 323

Rhus toxicodendron . . 242

Spongia 330

Stramonium .331, 237, 239

Sulphur 242, 334

Veratrum album

239» 240, 337

Mania, subacute 138

Nux vomica 241

Mania, syphilitic .... 152

Mania, traumatic 146

frequency 146

illustrative cases . 147, 150

pathology 146

symptoms 146

Marryatt 127

Masturbatic dementia . . .173

remedies 243

symptoms ... . 174

treatment 174

Materia medica, compendium

264

Mattress 258

Maudsley 94

INDEX.

349

Page.

Menander 68

Medulla oblongata i6

Melancholia ..... 94-126

causes 95i 99

definition, Maudsley*s . 94

forms 99, ICO

prevalence 123

prevention 123

Melancholia, acute .... 100
bed treatment f or . . .215

delusions 95

illustrative case .... 102

remedies 233

suicide 102

symptoms loo-ioi

terminations 102

Melancholia, acute delirious. 116
illustrative case . . . .119

symptoms 116

treatment 117

Melancholia with agitation. 115

Melancholia attonita . . . .110

causes 114

differential diagnosis . . iic
illustrative case . . . .117

remedies 118

symptoms 111-113

terminations 113

Melancholia, chronic . . . 105
illustrative case .... 106

symptoms 106

terminations 105

Melancholia, hypochondri-
acal 121

Melancholia, remedies . . . 233

Aconite 264

Actea racemosa .... 236

Alumina 267

Arsenicum .... 233, 274

Aurum 233, 276

Cactus 235, 281

Page.

Melancholia, Calcarea car-

bonicum 282

Coffea cruda . . . 234, 295

Digitalis 235, 299

Ferrum metallicum . . 300

Gelsemium 234

Helleborus niger . . . 303

Ignatia 234, 307

Iodine 309

Lilium tigrinum . . 236, 312

Lycopodium 313

Mercurius 314

Natrum muriaticum234, 316

Nux moschata 235

Nux vomica 318

Opium .... 235-236, 320

Podophyllum 324

Pulsatilla 235, 324

Sepia 236, 328

Silicea 329

Stramonium 331

Sulphur 334

Thuja 336

Veratrum album . . 236, 337
Zincum metallicum . . 340
Melancholia with resist-
ance 115

Melancholia, simple .... 100
Melancholia with stupor . . 1 10

causes 114

differential diagnosis . . 1 1 1
illustrative case . . . .117

remedies 118

symptoms 111-113

terminations 113

Melancholia, subacute . . . 100
Membranes of the brain . . 11

Memory, the 21

Mercurius 314

Mental processes 23

Michelet 35

350

INDEX.

Page.

Mickle 183

Milk, use of 223

Mitchell. S. Weir 62

Mizaldus 62

Mode of addressing the in-
sane 84

Monomania 155

Moral hygiene 227

Moral mania 155

Natrum muriaticum . . . .316

melancholia 234

Neuroglia, the 13

Neuron, the 13

Nerve cells 13

Nerve fibres 13

Nitric acid 317

Ntix moschata in melan-
cholia 235

Nux vomica 318

sleeplessness 66

subacute mania .... 241

Occupation for the insane . 220
Open-door system . . . 250

Operations 228-230

Opium 320

melancholia 236

mental weakness . . . 235

Organic dementia 176

causes 176

prognosis 176

Orificial surgery 228

Outbuildings 262

Paranoia .

forms

illustrative case . . .

symptoms

Paine*s feeding apparatus
Pantries in hospital wards
Passiflora in sleeplessness

139

139
140

140

222

259
67

Page

Paresis, general 182

bed treatment for . . .215

causes 200

convulsions 190

definition 183

differential diagnosis . 183

illustrative cases . . .

191* 194, 198

pathology 203

physical signs ... . 186

prevention 207

prognosis 205

stages 184

symptoms .... 185

treatment 205

Paroles 250

Patients, commitment ... 85

clothing required for . 91

Periodic mania 145

Phosphoric acid 321

mental weakness . . . 235

dementia 243, 288

Phosphorus 321

Phrenalgia 94

Pia mater 12

Picric acid 287

Pinel 72

Piscidia in sleeplessness . . 67

Platina 323

Podophyllum 324

Primary dementia 161

Agaricus 266

Anacardium 268

differential diagnosis

III, 162

Processes of mind ... .24

Protection sheet .

Puerperal mania .
causes . . .
Hyoscyamus
illustrative case

218, 219

• . 153

• • 153
. .305

• • 153

INDEX,

351

Page*

Puerperal mania, Veratrum

viride 339

Pulsatilla 324

melancholia 235

Pyromania 156

Reade 127

Recurrent mania 145

Requirements for commit-
ment in New York .85
examination by two
qualified medical ex-
aminers in lunacy . . 85
judicial order of com-
mitment by a judge
of a court of record . 88
personal service .... 87

petition 86

statement of financial
condition of patient . 88
iR^est in the care of the in-
sane 215

advantages 216

Rhus toxicodendron . . . 326

Rindfleisch 157

Rush 94, 142

Sanitariums 212

Samuel 69

Scalp, the 10

Scott 127

Secale cornutum 327

Senile dementia .... 177-180

diagnosis . . . . " 179-180

symptoms .... 177-180
Sepia 328

melancholia 236

Shakespeare

52-55, 100, 127, 170, 183
Silicea 329

epilepsy 244

Page.
Site for hospital for the in-
sane 246

Skae 146

Skull, the 10

Sleep, definition of ... . 55
anemia of brain .... 55

causes 56

induction of, .... 57-59

Sleeplessness 62

causes 57

remedies 63-67

Solanum carolinense in epi-
lepsy 244

Solariums 248

Spencer, Herbert 41

Spongia 330

Staphisagria 333

State hospitals 213

Steam heating 253

St. Dymphna 71

Stimulants 227, 245

Stramonium 331

mania 239

sleeplessness ..... 67
Subacute mania . . . . .138
Subacute melancholia . . . 104

Suicide, danger of 221

Sulci 13

Sulphur 334

mania 242

Syphilitic mania ... 152

Tarantula in mania .... 242
Terminal dementia .... 162

Thuja 336

Traumatic mania ..... 146

frequency 146

illustrative cases . 147, 150

pathology 146

symptoms 146

Tristimania 94

352

INDEX,

Treatment of insanity . 21 1-23 1

amusements 220

artificial feeding . . .221

home 212

in large hospital wards . 215

means for 214

medical 232

moral hygiene . . . .227

occupation 220

rest in bed .... 215-218

sanitarium 212

state hospital 213

surgical operations . .228

Van der Kolk 274

Velpeau . ... 19
Ventilation 250

Page.

Ventricles, brain 15

Veratrum album 337

history 240

mania 239, 240

melancholia 236

sleeplessness 67

Veratrum viride 339

mania 241

Wards^ arrangement of . . 248
Ward dining-rooms .... 259
Weight of brains .... 16-17

Will, the 24

Worry 58, 97

Zincum metallicum

340